Idiopathic Spontaneous Hemorrhage of the Right Colic Artery: A Rare Vascular Emergency

Spontaneous rupture of the right colic artery is an exceptionally rare cause of acute intra-abdominal bleeding, especially in the absence of trauma. Prompt recognition and intervention are critical, particularly in anticoagulated patients, to prevent hemodynamic collapse and death. We present the case of a 64-year-old man with a history of atrial fibrillation on apixaban who presented with sudden-onset severe abdominal pain, hypotension, and tachycardia. A CT of the abdomen demonstrated intraperitoneal hematoma with active arterial extravasation from a distal branch of the right colic artery arising from the superior mesenteric artery (SMA). The patient was administered prothrombin complex concentrate and IV fluids and underwent emergent superselective interventional radiology (IR)-guided embolization of the bleeding vessel. Spontaneous right colic artery rupture can be life-threatening, especially in anticoagulated patients. Early CT scans and IR intervention can be life-saving and avoid the need for exploratory surgery. Clinicians should maintain a high index of suspicion for visceral artery hemorrhage in patients presenting with acute abdomen.