Bleeding rectal pseudoaneurysm following endoscopic submucosal dissection managed with endoscopic ultrasound-guided...

Bleeding secondary to a pseudoaneurysm following endoscopic submucosal dissection (ESD) is exceedingly rare with limited cases reported.

A 74-year-old woman presented with recurrent hematochezia despite conventional endoscopic hemostasis following ESD of a 50-mm rectal polyp. The patient underwent computed tomography angiography that revealed a rectal pseudoaneurysm with active bleeding. She subsequently underwent flexible sigmoidoscopy with EUS. At the site of the adherent clot, a penetrating feeder arterial vessel in the adventitia with a small pseudoaneurysm in the rectal wall (intramural) could be identified on EUS with Doppler. Using a 19-gauge fine-needle aspiration needle primed with saline, we injected 6 mL of absorbable gelatin sponge into the vessel as well as the pseudoaneurysm by EUS guidance, with immediate decrease in Doppler flow after the injection.

The patient did well postprocedurally without any recurrent episodes of bleeding, and repeat imaging did not show evidence of a persistent pseudoaneurysm.

Arterial pseudoaneurysm is a rare but serious adverse event following ESD. In cases refractory to conventional endoscopic therapy, EUS-guided embolization may offer an effective treatment option.