Prostatic biopsy-related rectal bleeding refractory to medical and endoscopic therapy definitively managed by catheter-directed embolotherapy: a case report

Abstract

IntroductionUltrasound-guided transrectal prostatic biopsy is generally a well-tolerated radiological technique with low overall complication ratio. If post-biopsy rectal bleeding occurs, conservative management is effective in the majority of cases. Endoscopic or interventional treatment is rarely required.Case presentationWe report the case of an 82-year-old white man presenting with massive rectal bleeding after ultrasound-guided prostatic biopsy. Medical and endoscopic management were not effective. Angiographic evaluation revealed a prostatic arteriovenous fistula, and definitive treatment was provided in the form of catheter-directed superselective embolotherapy.ConclusionTransrectal prostatic biopsy may be associated with massive rectal bleeding. Transcatheter embolotherapy can be effective in definitively stopping the bleeding.

Late-onset rectal bleeding with hemorrhagic shock after transrectal prostate needle biopsy

“…Several case reports have been published regarding patients who required aggressive treatment, including blood transfusion, because of late-onset massive rectal bleeding. 2 , 3 , 4 Recently, several risk factors for rectal bleeding have been suggested, such as increasing biopsy core numbers, advanced age, poorly controlled hypertension, and constipation, whereas the influence of antiplatelets remains controversial. 2 Because these risk factors would increase according to the age of patients and the expansion of prostate biopsy indications, a risk of severe rectal bleeding should be considered.…”

“…According to few case reports, angiography could reveal the existence of bleeding or abnormality of the superior rectal artery or prostate artery, resulting in rectal bleeding with or without retroperitoneal bleeding, and arterial embolization could arrest the bleeding. 2 , 4 , 5 Because arterial embolization was advantageous in a patient with retroperitoneal hemorrhage who could not be managed using colorectal endoscopy, it can be stated that arterial embolization is a definitive method for arresting rectal bleeding.…”

Fístula arteriovenosa iliaca-rectal como causa de rectorragia recurrente. Reporte de caso y breve revisión anatómica

“…5 En aquellos pacientes que buscan atención médica, el manejo diagnós-tico frente a este fenómeno no es del todo apropiado, ya que frecuentemente se omite la realización de un examen rectal, abdominal y el envío de pruebas complementarias. 6 La iatrogenia es un importante factor causal de sangrado masivo rectal, [7][8][9][10] igualmente hay múltiples entidades patológicas asociadas de forma infrecuente a rectorragia masiva tales como várices hemorroidales, 11 hemangiomas, 12 úlceras rectales asociadas a enfermedades autoinmunes 13 e infecciones. 14,15 Posterior a una revisión de las bases de datos de Ebscohost y Google scholar no fue posible documentar en la literatura un caso más de malformación en estos vasos particulares, aunque sí se detectaron otras malformaciones vasculares a nivel de la fosa isquioanal, 16 rectal externo y las ramas de las arterias iliacas internas como la causa de sangrado rectal recidivante y describir brevemente la anatomía vascular del recto, con la finalidad de que nuestra experiencia sea de utilidad en el momento de enfrentarse a un paciente con una presentación clínica similar.…”