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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.

Uterine artery embolisation can be used as a minimally invasive technique for the management of benign gynaecological conditions refractory to other medical treatments. The Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Radiologists (RCR) recommend the use of interventional radiology (IR) techniques for the prophylaxis and management of postpartum haemorrhage. Interventional radiologists can percutaneously drain postoperative collections or tubo-ovarian abscesses. Interventional radiology plays a role in the management of early pregnancy complications such as ectopic pregnancy and gestational trophoblastic disease. Interventional radiology can aid the care of patients with gynaecological malignancies. Learning objectivesTo understand the various IR techniques applicable to obstetrics and gynaecology To understand the risk and benefit profiles of these techniques To understand when the techniques could be appropriate and how they compare to surgical alternatives Ethical issuesThere are limited data regarding the use of some IR procedures owing to the ethical issues of using experimental techniques to treat pregnant women or women who wish to conceive. The availability of IR procedures is hospital specific so treatment is not available to all who may benefit.