Preoperative rectal tumor embolization as an adjunctive tool for bloodless abdominoperineal excision: A case report

Figure 1 Computed tomography scans with vascular reconstruction. A: A bulky rectal tumor with B: Marked hypervascularization.

Figure 2 Preoperative embolization. A: Digital subtraction angiography (DSA) of the inferior mesenteric artery identifying the enlarged superior rectal artery with prominent branches supplying the rectal tumor; B: DSA of the inferior mesenteric artery after 300-500 micra tris-acryl gelatin microspheres distal embolization into the superior rectal artery and partial occlusion of its main branch with controlled detachable platinum coils; C: Final DSA control of the inferior mesenteric artery after injection of N-butyl-2 cyanoacrylate with ethiodol 1:4 at the bifurcation of the right and left branches of the superior rectal artery, showing a significant reduction in distal arterial supply.

Figure 3 Surgical specimen after abdominal perineal resection. A: Total mesorectal excision; B: Extensive tumor necrosis can be observed after opening the surgical specimen.

Figure 4 Rectal adenocarcinoma (thick arrows) showing extensive tumor necrosis (thin arrows). Hematoxylin and Eosin stain, × 40 magnification.