Aberrant celio-mesenteric supply of the splenic flexure: Provoking a bleed

Figure 1 Computed tomography angiography with arterial phase (20 s following injection) acquisition. A, B: Axial image (A) and coronal images (B) demonstrating active contrast extravasation (arrows) at the splenic flexure; C: Coronal reformatted image demonstrating a celio-mesenteric branch (arrow) arising from the common hepatic artery (arrowhead); D: Seen in the large bowel mesentery (arrow) and supplying the splenic flexure.

Figure 2 Digital subtraction angiogram. A: Sim 1 catheter (white arrow) engaged in the common hepatic artery and a microcatheter (arrowhead) cannulating the celio-mesenteric trunk (black arrow) supplying the splenic flexure (asterisk) with no active hemorrhage seen; B: Active contrast extravasation (arrow) following instillation of 1 mg tPA; C: Angiogram following deployment of coils in branches of the celio-mesenteric vessel and no further active extravasation seen (arrow).