Acute retroperitoneal bleeding due to inferior mesenteric artery aneurysm: Case report

Pérez-Vallecillos, P; Conde-Muiño, Raquel; Segura-Jiménez, Inmaculada; Maldonado-Fernández, N.; Ferrón, JA; García-Róspide, V.; Palma, Pablo

doi:10.1186/1471-230x-10-59

Cited by 20 publications

(10 citation statements)

References 6 publications

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“…The commonest sites of visecral artery pseudoaneurysms are the splenic artery-gastroduodenal artery, hepatic artery, superior mesenteric artery, and celiac trunk and are commonly associated with pancreatitis [2][3][4]. Visceral artery pseudoaneurysms are common secondary to pancreatitis.…”

Section: To the Editormentioning

confidence: 98%

Traumatic Pseudoaneurysm of the Inferior Mesenteric Artery Branch: A Rare Cause of Lower GI Bleeding and Treatment with Selective Coil Embolization

Nagarajan

Elango

Laroiya

et al. 2016

Cardiovasc Intervent Radiol

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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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Section: To the Editormentioning

confidence: 98%

Traumatic Pseudoaneurysm of the Inferior Mesenteric Artery Branch: A Rare Cause of Lower GI Bleeding and Treatment with Selective Coil Embolization

Nagarajan

Elango

Laroiya

et al. 2016

Cardiovasc Intervent Radiol

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“…9,10 In our experience, the patient was asymptomatic, and the diagnosis was first made during a routine ultrasound scan performed to check the status of the aortoiliac district and then confirmed by CT scans.…”

Section: Discussionmentioning

confidence: 99%

A case of atherosclerotic inferior mesenteric artery aneurysm secondary to high flow state

Troisi

Esposito

Cefalì

et al. 2011

Journal of Vascular Surgery

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Inferior mesenteric artery aneurysms are very rare and they are among the rarest of visceral artery aneurysms. Sometimes, the distribution of the blood flow due to chronic atherosclerotic occlusion of some arteries can establish an increased flow into a particular supplying district (high flow state). A high flow state in a stenotic inferior mesenteric artery in compensation for a mesenteric occlusive disease can produce a rare form of aneurysm. We report the case of an atherosclerotic inferior mesenteric aneurysm secondary to high flow state (association with occlusion of the celiac trunk and severe stenosis of the superior mesenteric artery), treated by open surgical approach.

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“…atvejų. Taip pat nustatyta, kad viršutinės pasaito arterijos ir pilvinio kamieno susiaurėjimas didina apatinės pasaito arterijos aneurizmos riziką [4,5,6].…”

Section: Patogenezėunclassified

Visceralinės Aneurizmos: Literatūros Apžvalga

Kvietkauskas¹

2017

Medicinos Teorija Ir Praktika

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Reikšminiai žodžiai: visceralinių arterijų aneurizmos, visceralinės aneurizmos, aneurizmos plyšimas. Straipsnyje pateikiama visceralinių aneurizmų literatūros apžvalga. Iki šiol literatūroje apie šią patologiją publikuota per 4 000 straipsnių. Pirmasis visceralinę aneurizmą aprašė prancūzas Beaussiers 1770 metais. Visceralinėmis aneurizmomis vadinamos pilvinio kamieno, viršutinės ir apatinės pasaito, inkstų arterijų ir jų šakų aneurizmos. Jų sutinkama ne daugiau kaip 2 proc. populiacijos. Visceralinės aneurizmos skirstomos į tikras visceralines aneurizmas ir pseudoaneurizmas. Pastarosios aptinkamos dvigubai dažniau nei tikros visceralinės aneurizmos. Dažniausiai tikrosios aneurizmos susiformuoja dėl aterosklerozės, fibromuskulinės displazijos arba traumos, o pseudoaneurizmas dažniausiai sukelia pankreatitai. Pagal klinikinę stadiją skiriamos asimptominės, simptominės ir plyšusios visceralinės aneurizmos. Pastarosios pasižymi ypač dideliu mirtingumu. Visceralinės aneurizmos dažniausiai pažeidžia blužnies arterijas, rečiau – kepenų, inkstų, ypač retai – kitas visceralines arterijas. Pagrindiniai diagnostikos iššūkiai – labai įvairi ir nespecifinė visceralinių aneurizmų klinika. Pagrindinės diagnostikos naujovės – didesnės raiškos ir erdvinės vaizdinių tyrimų atmainos. Planinis invazinis gydymas taikytinas, jei visceralinių aneurizmų diametras ≥ 2 cm, taip pat kai kurių išimčių atvejais – nepriklausomai nuo aneurizmos dydžio. Esant simptominėms aneurizmoms, intervencija turi būti atliekama neatidėliotinai, o plyšusių atvejais – skubiai. Minimaliai invaziniai gydymo metodai pamažu tampa pagrindiniai gydant visceralines aneurizmas. Ypač gerų rezultatų ateityje tikimasi gydant aneurizmas srovę nukreipiančiais stentais, kai jie taps prieinamesni.

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Acute retroperitoneal bleeding due to inferior mesenteric artery aneurysm: Case report

Cited by 20 publications

References 6 publications

Traumatic Pseudoaneurysm of the Inferior Mesenteric Artery Branch: A Rare Cause of Lower GI Bleeding and Treatment with Selective Coil Embolization

Traumatic Pseudoaneurysm of the Inferior Mesenteric Artery Branch: A Rare Cause of Lower GI Bleeding and Treatment with Selective Coil Embolization

A case of atherosclerotic inferior mesenteric artery aneurysm secondary to high flow state

Visceralinės Aneurizmos: Literatūros Apžvalga

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