A Case of Asymptomatic Focal Colonic Necrosis after Selective NBCA-TAE for the Primary Treatment of Acute Diverticular Hemorrhage

Abstract

A 79-year-old man was admitted with the chief complaint of bloody bowel discharge. Hemorrhage was not present at the time of admission, but recurred on the 4th hospital day. Urgent colonoscopy (CF) demonstratd hemorrhage in an ascending colon diverticulum We could not achieve complete hemostasis using CF, so we performed urgent angiography. We identified the site of active hemorrhage, and performed selective transarterial embolization (TAE) using NBCA (N-butyl-2-cyanoacrylate). After TAE, we planned to perform colectomy including the embolized segment, and monitored the patient's course. Since he had no further abdominal symptoms, we performed elective surgery 4 days after TAE. At surgery, we found a full-thickness, circular necrotic focus in the ascending colon. We conducted right hemicolectomy to include multiple diverticula including the necrotic focus. The wound site became infected after surgery, but improved with the discharge of pus. We report a case in which asymptomatic colonic necrosis spontaneously resolved after selective TAE for colonic diverticular hemorrhage.