Massive per rectal bleeding in a child due to caecal arteriovenous malformation treated successfully by embolisation

Area of Science:

• Interventional Radiology
• Pediatric Surgery
• Vascular Malformations

Background:

• Arteriovenous malformations (AVMs) are rare vascular anomalies that can present with significant complications.
• Gastrointestinal AVMs, particularly in the pediatric population, pose diagnostic and therapeutic challenges.
• Massive lower gastrointestinal bleeding can lead to hemodynamic instability and shock.

Observation:

• A 12-year-old girl presented with sudden, massive per rectal bleeding and hypotensive shock.
• Computed tomography (CT) angiography revealed active arterial bleeding from a cecal arteriovenous malformation.
• The patient required immediate resuscitation and activation of a massive hemorrhage protocol.

Findings:

• Therapeutic embolization was chosen as the primary treatment modality over immediate surgery.
• The superior mesenteric artery was catheterized via a right femoral approach under local anesthesia.
• Successful embolization of the bleeding vessel was achieved using two microcoils, controlling the hemorrhage.

Implications:

• Endovascular embolization is a viable and effective treatment for pediatric patients with cecal arteriovenous malformations presenting with massive bleeding.
• Minimally invasive endovascular techniques can obviate the need for major surgery in select cases.
• Multidisciplinary collaboration between interventional radiology, surgery, and pediatrics is crucial for optimal management of complex vascular anomalies.