Internal Iliac Aneurysm Rupture into the Rectum following Endovascular Exclusion: An Unusual Cause of Massive Lower Gastrointestinal Bleeding

Karkos, Christos D.; Oshodi, Taohid O.; Vimalachandran, Dale; Abraham, John S.; Adiseshiah, M

doi:10.1177/152660280200900627

Cited by 17 publications

(11 citation statements)

References 18 publications

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“…Internal iliac artery aneurysm-colonic fi stulae can be treated for example, by aneurysmorrhaphy of the IIAA, ligation of the communicating vessel, colostomy, the Hartmann procedure and revascularization (femorofemoral bypass etc.). 5,6) However, radical surgery for the IIAA-colonic fi stula in our patient was not an option, and thus he underwent palliative procedures with a colostomy and the IIAA remained intact. The patient remained free of melena and symptoms of infection for over 1 year without antibiotics.…”

Section: Discussionmentioning

confidence: 81%

“…[1][2][3][4][5][6] Treatment for IIAA comprises open surgery (resection of aneurysm) or EVAR. Open surgery for IIAA was not an option for our patient because of a hostile abdomen, and thus less-invasive EVAR with coil embolization was selected.…”

Section: Discussionmentioning

confidence: 99%

“…1) Such aneurysms sometimes create fi stulae near organs such as the bladder, ureter, vein and intestinal tract. [1][2][3][4][5][6] We describe the rare development of a fi stula between the sigmoid colon and a residual IIAA that developed in a patient 3 years after undergoing endovascular abdominal aortic repair (EVAR).…”

Section: Introductionmentioning

confidence: 99%

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Internal Iliac Artery Aneurysmo–Colonic Fistula after Endovascular Stent-Graft Repair: A Case Report

Yanase

Fukada

Tamiya

2015

Annals of Vascular Diseases

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left IIAA (maximum diameter 50 mm) 3 years previously. The distal branches of the internal iliac artery were not occluded, but the distal main trunk of the IIAA was treated by coil embolization. Endovascular abdominal aortic repair was originally selected because he had a history of total gastrectomy for gastric cancer as well as unknown procedures to treat colon and rectal cancer via several laparotomies. Postoperative computed tomography (CT) after EVAR revealed the absence of endoleaks and an unchanged aneurysmal diameter (Fig. 1). A high fever suddenly developed 32 months later, and his general practitioner found the following: white blood cells 8,400/µL and C-reactive protein, 5.8 mg/dL, indicating infl ammatory changes. All other fi ndings were unremarkable. He was prescribed with oral antibiotics (Cefcapene pivoxil hydrochloride hydrate, 200 mg/day) and sent home. However, he was admitted to hospital one week later with persistent fever and black tarry stools. The physical fi ndings upon admission were as follows: body temperature, 38°C; blood pressure, 158/70 mmHg; heart rate, 70 beats/ min. Plain CT showed that although the diameter of the IIAA sac had remained at 50 mm, it contained air bubbles (Fig. 2a). Colon fi berscopy revealed an ulcer at the sigmoid colon. Retrograde colonography showed gastrografi n running into the IIAA sac (Fig. 2b). These fi ndings confi rmed a left IIAA-sigmoid colonic fi stula without active bleeding from the IIAA. Gastroenterological surgeons ruled out radical surgery for IIAA-colonic fi stula for this compromised patient and palliative surgery (colostomy creation) proceeded via a median laparotomy. Intraperitoneal adhesions were so severe that they could not be divided, especially between the sigmoid colon and the IIAA, and thus the sigmoid colon was transected at the oral position of the fi stula. A colostomy was created at the oral side of the stump, the anal side of which was closed. The IIAA and the stent-graft remained untouched. The patient was post-surgically administered with meropenem (1 g/day for two weeks) and sulfamethoxazoletrimethoprim (1,800 mg/day for 5 months). The patient has remained free of symptoms of infection and melena for 1 year (Fig. 3).We describe rare ilio-enteric fi stula that developed after endovascular repair of a left internal iliac artery aneurysm (IIAA). An 83-year-old man with a history of previous surgeries via laparotomies suddenly developed a high fever 3 years after undergoing endovascular abdominal aortic repair (EVAR) with a stent-graft to treat a left isolated IIAA. Computed tomography imaging revealed a fi stula between the IIAA and the sigmoid colon. A colostomy was created because severe intraperitoneal adhesions prevented resection of the IIAA. The postoperative course was uneventful and the patient remained free of infection without antibiotics. Residual aneurysms can cause complications after EVAR.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

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Internal Iliac Artery Aneurysmo–Colonic Fistula after Endovascular Stent-Graft Repair: A Case Report

Yanase

Fukada

Tamiya

2015

Annals of Vascular Diseases

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“…Otherwise, the combined use of multiple coils and/or AVPs seems to be inevitable, as embolization of both afferent and efferent arteries of the IIA aneurysm is necessary. 13,14 A few studies have been published comparing proximal plug embolization vs distal embolization (DistEmbX) with coils and/or plugs. 11,12,15 However, no study has set a special focus on presence of distal aneurysmatic disease.…”

Section: Endovascular Aneurysm Repair (Evar) Is An Established Alternmentioning

confidence: 99%

Proximal occlusion of unaffected internal iliac artery versus distal occlusion of aneurysmatic internal iliac artery prior to EVAR: a comparative evaluation of efficacy and clinical outcome

Dierks

Sauer

Wolfschmidt

et al. 2017

BJR

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“…Auch bei dieser Technik ist eine Embolisation des Aneurysmas mit Coils oder eine alleinige Aneurysmaexklusion mittels Stent-graftImplantation über den Abgang der Arteria iliaca interna nicht ausreichend. Um eine anhaltende Aneurysmaperfusion mit drohender Spätruptur zu vermeiden, müssen zuerst alle abgehenden Seitenäste embolisiert werden und das Aneurysma durch Stent-graft-Implantation exkludiert werden [3]. Wie bei endovaskulär behandelten abdominellen Aortenaneurysmen erscheint auch hier eine lebenslange Kontrolle angezeigt, um Komplikationen wie Stent-graft-Migration, Endoleaks mit Reperfusion und Aneurysmagrößenzunahme rechtzeitig zu erkennen.…”

Section: Diskussionunclassified

Ruptur eines Aneurysmas der Arteria iliaca interna

2003

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Isolated aneurysms of the iliac arteries are rare. Located deep in the lesser pelvis, they are diagnosed late or in a symptomatic stage. Because of their manifold anatomic relationships to pelvic structures, iliac aneurysms may cause different symptoms such as obstipation, hydronephrosis, venous thrombosis, and entrapment neuropathy. Aneurysm rupture is associated with high mortality. The rupture of an iliac aneurysm into the rectum with massive lower intestinal bleeding is extremely rare. We report a patient with 6-year follow-up after aneurysm resection, extra-anatomic bypass, and suture repair of the rectum with temporary colostomy.

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Internal Iliac Aneurysm Rupture into the Rectum following Endovascular Exclusion: An Unusual Cause of Massive Lower Gastrointestinal Bleeding

Abstract: An iliorectal fistula is an extremely rare and unlikely complication of coil occlusion of an iliac aneurysm. A high index of suspicion for the diagnosis is of paramount importance. Periodic imaging in these patients is required to detect recanalization and continuing aneurysm expansion.

Cited by 17 publications

References 18 publications

Internal Iliac Artery Aneurysmo–Colonic Fistula after Endovascular Stent-Graft Repair: A Case Report

Internal Iliac Artery Aneurysmo–Colonic Fistula after Endovascular Stent-Graft Repair: A Case Report

Proximal occlusion of unaffected internal iliac artery versus distal occlusion of aneurysmatic internal iliac artery prior to EVAR: a comparative evaluation of efficacy and clinical outcome

Ruptur eines Aneurysmas der Arteria iliaca interna

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