Vascular Injury Following Pyloric Dilation: Unusual Cause of Ischemic Colitis

A 57-year-old female with intrahepatic cholangiocarcinoma underwent hepatic trisegmentectomy and chemoradiation. Her course was complicated by recurrent episodes of radiation-induced gastric outlet obstruction requiring balloon dilations. She presented with right lower quadrant pain after routine upper endoscopy with pyloric dilation. A computed tomography (CT) showed isolated right-sided ischemic colitis with vascular contrast in the mesentery. Repeat CT after conservative management revealed near resolution of the ischemic changes. Perforation at the level of the pylorus is a complication of endoscopic pyloric dilation but vascular injury has never been described.