Lower Gastrointestinal Hemorrhage Caused by Superior Rectal Artery Pseudoaneurysm

Abstract

Acute lower gastrointestinal (GI) bleeding is self-limiting and managed conservatively. Ongoing bleeding from a lower GI source and hemodynamic instability can create difficult diagnostic and therapeutic dilemmas. The severity of bleeding can necessitate emergent diagnostic and therapeutic interventions. Diverticulosis and angiodysplasias are the most common causes of massive lower GI hemorrhage. Other etiologies that can lead to life-threatening hemorrhage are important to recognize. We present a rare case of massive lower GI hemorrhage attributable to a superior rectal artery pseudoaneurysm. The absence of a preceding traumatic or iatrogenic cause distinguishes this case from other reports in the literature.

Successful minimal invasive treatment of massive colonic bleeding from a pseudoaneurysm in a Nigerian with end-stage kidney disease: A case report

“…As well as providing for swift and accurate localization of the bleeding lesion, it also provides a window for endovascular therapeutic techniques which have reduced the frequency of emergent surgical bowel resection and its attendant morbidity and mortality. [1,6] The exact cause of pseudoaneurysm in our index patient still remains obscure as there was no traceable penetrating trauma, connective tissue disease, vasculitis, or colorectal malignancy. Though the patient in this case report was on long-term hemodialysis therapy for end-stage kidney disease, scientific literature is silent on whether there is a link between the two disease entities.…”

The role of repeated imaging in detecting complications in the post‐operative period following pancreaticoduodenectomy

“…The nature of pseudoaneurysms and their associated fragile walls (fibrin/platelet crosslinks), exposed to internal forces such as high blood pressure, predisposes them to a higher risk of bleeding than a true aneurysm. 18 Advances in imaging technology and interventional radiology (IR) has had an substantial impact on both the diagnosis and the management of peripancreatic pseudoaneurysms and post-PD haemorrhage with significant reductions in mortality when compared to surgical management alone. 12,19 When available, early imaging and appropriate management with IR is recommended and can avoid the additional late mortality and morbidity associated with delayed treatment.…”

“…Compared to the normal trilaminar structure of a true aneurysm (intima, media, adventitia), pseudoaneurysms result from injury to one or more vessel wall layers resulting in a wall comprised of surrounding fibrous tissue. The nature of pseudoaneurysms and their associated fragile walls (fibrin/platelet crosslinks), exposed to internal forces such as high blood pressure, predisposes them to a higher risk of bleeding than a true aneurysm 18 …”