Rectal infarction caused by transcatheter arterial embolization of the superior rectal artery below the Sudeck's point: A case report

Abstract BACKGROUND Transcatheter arterial embolization (TAE) is the first-line treatment for lower gastrointestinal bleeding. Previous reports have examined the safety and efficacy of TAE, but few studies have assessed its complications. Some studies have only statistically analyzed complication incidence, but it is relatively plain to discuss the causes. Here we emphasize the Sudeck's point as watershed areas for colonic blood supply. Especially for those rare cases which are lack of anastomosis between the sigmoid artery and the superior rectal artery, that should be taken into serious consideration by both surgeons and interventionists. CASE SUMMARY In this case, the patient was diagnosed with malignant rectal tumor bleeding. Because the tumor blocked the intestinal lumen, the endoscope could not reach the bleeding site. Therefore, Transcatheter arterial embolization was selected as a hemostatic measure. The superior rectal artery below the Sudeck's point was utilized as the embolization site. Spring coil and Gelfoam were used as embolization materials. However, laparoscopic exploration revealed ischemic necrosis of the upper rectum 25 h later. Due to the lack of blood transport, bowel anastomosis could not be completed after tumor resection, and a sigmoid colostomy was required. CONCLUSION When transcatheter arterial embolization serves as an adjunctive therapy, it aims to reduce arterial perfusion pressure rather than to completely occlude the blood vessel. The choice of embolization materials and location is extremely important.