Right Hemicolectomy for Refractory Hematochezia in Cecal Angiodysplasia After Failed Embolization: A Case Report.

Angiodysplasia is an acquired vascular malformation that accounts for a substantial proportion of lower gastrointestinal bleeding in older adults, most often involving the cecum and ascending colon. Although endoscopic and endovascular therapies are considered first-line treatments, a subset of patients develops refractory bleeding that requires a multimodal approach. The objective of this case report is to highlight the management of early endovascular failure in a well-localized cecal angiodysplasia and to illustrate the role of timely right hemicolectomy in achieving sustained remission. We describe a 67-year-old Hispanic man, a former school teacher with long-standing hypertension and chronic diclofenac use, who presented with recurrent hematochezia and severe iron-deficiency anemia. Despite multiple endoscopic evaluations and medical therapy with proton pump inhibitors and somatostatin analogs, bleeding persisted. Dynamic computed tomography angiography demonstrated cecal angiodysplasia, and selective transcatheter arterial embolization using distal microparticles was performed. However, early rebleeding occurred within ten days, most likely due to rapid vascular recanalization of the embolized branch, a known limitation of particle embolization in this territory, ultimately necessitating right hemicolectomy, which achieved durable control of overt bleeding at six‑month follow‑up. This case illustrates the limitations of endovascular therapy in refractory angiodysplasia and underscores the importance of careful vascular assessment when selecting embolic agents, particularly in patients with proangiogenic factors such as chronic nonsteroidal anti-inflammatory drug (NSAID) exposure. We briefly review current evidence on the diagnostic role of dynamic computed tomography angiography and the position of surgery within a multidisciplinary strategy for complex gastrointestinal angiodysplasia. Refractory gastrointestinal angiodysplasia should be approached as a systemic vascular disorder requiring individualized, multimodal management. Even in the era of advanced endoscopic and endovascular therapies, surgery remains an essential definitive option for selected patients in whom bleeding persists despite optimized minimally invasive interventions. From the patient's perspective, definitive surgery was perceived as a last resort but an ultimately reassuring solution after months of transfusion-dependent bleeding.