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

Abstract

A 12-year-old girl presented with a sudden onset of per rectal bleeding. After admission, she had further episodes of large volume per rectal bleeding and developed hypotensive shock. Hence a massive haemorrhage protocol was activated. Surgical, paediatric and anaesthetic support was sought immediately. Further resuscitation with packed red cells, platelets and fresh frozen plasma was successful. An urgent CT angiogram of the abdomen confirmed active arterial bleeding from an arteriovenous malformation in the caecum. After a detailed discussion between the surgeons and the interventional radiologists, it was decided to attempt therapeutic embolisation first, failing which surgery was the option. The patient and family were fully informed. Through a right femoral approach under local anaesthesia, the superior mesenteric artery was catheterised and the bleeding vessel was successfully controlled with two microembolisation coils. Except for some initial abdominal discomfort, she made an uneventful recovery and was discharged home.