A forty-five-year-old man presented to emergency services with history of assault on the abdomen by a blunt object. He presented with diffuse abdominal pain and inability to pass stools and flatus. On examination, diffuse abdominal tenderness was present with guarding and rigidity. Emergency plain CT revealed perforation with free air in abdomen. Free air surrounding ileum and sigmoid loops was noted, suggesting the possibility of perforation. Patient was taken for immediate laparotomy in which about 2-2.5 L of hemoperitoneum was present. Sigmoid mesocolon perforation was noted with dusky appearing sigmoid colon. Resection of injured bowel with anastomosis was performed. Two perforations in the ileum were noted approximately 120 cm from the ileocecal junction and about 5 cm of ileum at that region appeared dusky. Resection of around 30 cm of ileum was done and brought out as ileostomy. Two mesenteric tears were noted involving mesentery of ileum, which were closed. He was on elective ventilation for 2 days and extubated. On tenth post-operative day, he developed hematemesis, and it was thought to be due to his alcoholic liver disease and was conservatively managed. Patient was transfused with 4 units of fresh frozen plasma during procedure. Twenty days after the resection and anastomosis, he developed bleeding per rectum of about 500 ml (of both fresh blood with clots). Emergency CECT revealed pseudoaneurysm probably arising from the inferior mesenteric artery branch that probably communicated with the sigmoid colon (Fig. 1A, B). The pseudoaneurysm was located in the region of the sigmoid mesocolon tear. The pseudoaneurysm measured about 2.2 9 2.0 cm. No active extravasation was noted. In this case, recent laparotomy along with poor general condition of the patient meant endovascular intervention was the only option available. Patient was taken up for emergency coil embolization, as another episode of hematochezia might be fatal. Informed written consent for the procedure was taken from the patient and his wife. As it was done as emergency life-saving step, approval from Institutional Review Board was not required. Through left brachial arterial access, the inferior mesenteric artery (IMA) was catheterized using a 4F diagnostic catheter, and diagnostic angiogram was done. The left brachial approach was chosen as femoral approach was unsuccessful in reaching the sigmoid branch as normally inferior mesenteric artery has acute angle take-off from the aorta. Digital Subtraction Angiography (DSA) confirmed a pseudoaneurysm arising from the sigmoid branch of IMA between the left colic and superior rectal branches (Fig. 2A). The pseudoaneurysm measured about 2.2 9 2.0 cm with distal branch continuing toward the sigmoid. There were no branches distal to the pseudoaneurysm. Due to nature of pseudoaneurysm in the setting of acute massive rectal bleeding of more than 500 ml, coil embolization was considered in the proximal artery rather than within the pseudoaneurysmal sac itself. The left colic and marginal artery appeared...

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