Direct-stick embolization to treat hematochezia secondary to rectally metastatic sacral neuroblastoma

Neuroblastoma is a malignant tumor that is typically treated with a combination of surgery, radiation therapy, chemotherapy, and immunotherapy. However, minimally invasive embolization and chemoembolization present promising new treatment modalities. We present the case of a 6-year-old patient who initially presented with a massive lower GI bleed due to sacral neuroblastoma metastasis invading the rectum, that was managed via transarterial embolization and transrectal endoscopic-guided percutaneous nBCA embolization. There was significant tumoral supply from the posterior division of the internal iliac arteries treated with coil, liquid, and particle embolics. Subsequently, under endoscopic guidance, liquid embolization via direct puncture of the rectal metastasis was performed to manage any residual vascularity. Thereafter, the patient's lower GI bleed resolved. Direct puncture tumoral embolization offers a potentially highly effective, yet minimally invasive procedure that warrants further evaluation.