Crohn’s Disease and Jejunal Artery Aneurysms: A Report of the First Case and a Review of the Literature

Abstract

Background and Objectives: Jejunal artery (JA) and ileal artery (IA) aneurysms constitute less than 3% of all visceral artery aneurysms (VAAs), carrying a risk of rupture as high as 30%, and a mortality of 20%. Though many etiologies have been reported in the literature, no mention exists on a causal association between these aneurysms and inflammatory bowel diseases (IBD). We present the first case of a JA aneurysm related to Crohn’s Disease (CD) together with a review of the literature. Materials and Methods: A 74-year-old male presenting with CD intestinal relapse and an incidental finding at the computed tomography enterography (CTE) of a 53 × 47 × 25mm apparently intact JA pseudoaneurysm, arising from the first and second jejunal branches, underwent coil embolization followed by small bowel resection, with an uneventful outcome. We also included the review of literature on JA and IA aneurysms, analyzing all reports published in PubMed and Scopus from 1943 to July 2022. Results: 60 manuscripts with 103 cases of JA and IA aneurysms in 100 patients were identified. Among cases with available data, 34 (33.0%) presented acutely with rupture, 45 (43.7%) were described as non-ruptured. 83 (80.6%), and 14 (13.6%) were JA and IA aneurysms, respectively, having a median size of 15 (range:3.5–52) mm. Atherosclerosis (16.5%), infections (10.7%), and vasculitides/connective tissue disorders (9.7%) represented the main causes mentioned. Mean age was 53.6 (±19.2) years, male patients being 59.4%. One third of patients (32.4%) were asymptomatic. Overall, treatment was indicated in 63% of patients, with surgery and endovascular procedures performed in 61.9% and 38.1% cases, respectively. The technical success rate of endovascular treatment (EVT) was 95.8%. The mortality rate was 11.8%, being higher (21.2%) in the rupture group. Conclusions: The prompt treatment accomplished in our case granted a successful outcome. JA and IA aneurysms should be included among local complications of IBD. Considering their high potential for rupture, regardless of size, a low threshold for endovascular or surgical treatment should be applied.

Familial visceral branch artery aneurysms in Loeys-Dietz syndrome

“…Distal SMA branch vessel aneurysms are exceedingly rare 8. A literature review spanning 80 years identified just 103 cases of jejunal and ileal artery aneurysms,9 the majority of which were due to atherosclerotic, infectious or inflammatory (most often polyarteritis nodosa) aetiologies 9. Ileocolic artery aneurysms account for only 3% of all visceral artery aneurysms 10.…”

A mycotic aneurysm of a jejunal branch treated by aneurysmectomy without bowel resection

“…A few case reports have described simple ligation and excision of a jejunal branch as an option if the collateral blood flow is adequate and the bowel seems viable. 11 Only six other mycotic jejunal pseudoaneurysm cases are documented, four involving aneurysmectomy alone, one involving ligation and excision with segmental bowel resection, and one treated conservatively without surgical intervention due to its distal location. 19 , 21 , 22 , 23 …”

Transarterial Embolization of Visceral Artery Aneurysms

“…In cases where the exact bleeding localization can be determined by angio-CT before the minimally invasive procedure, it proves beneficial for subsequent emergency angiography. In critical conditions, emergency angiography can be performed as an overview, followed by selective and superselective imaging to locate the bleeding source, leading to immediate embolization (34,35). With the continuous development of endovascular transcatheter embolization techniques, careful consideration is given to the placement of embolization material, primarily coils, alone or in combination with liquid embolics.…”