Spontaneous inferior epigastric artery pseudoaneurysm

Abstract

A case of spontaneous pseudoaneurysm of the inferior epigastric artery-diagnosed on Doppler sonography-is presented. A 19-year-old boy presented with a lump in the anterior abdominal wall. Clinically a smooth, nontender, and noncompressible mass was present above umbilicus to the right of midline. A bruit was heard over the swelling. Doppler sonography demonstrated an oval hypoechoic structure in the right rectus sheath with turbulent flow. The pseudoaneurysm could be traced to the inferior epigastric artery. Surgical excision of pseudoaneurysm was performed. Histopathology showed myxoid changes in the wall of the pseudoaneurysm with no inflammatory changes.

Inferior Epigastric Artery Pseudoaneurysm in a Kidney Transplant Recipient

“…From its origin, it courses upward and medially to enter the rectus sheath. Within the rectus sheath, it lies just at anterior to posterior wall of the sheath [1]. Pseudoaneurysm of the IEA is a recognised but very rare clinical entity with just a few cases reported in the literature as complication of surgery, trauma, and arterial puncture [2–4].…”

“…Lam et al suggested that percutaneous transcatheter techniques may be preferable in patients with portal hypertension caused by chronic liver disease, who often have a coagulopathy and increased venous collateral in their abdominal wall [8]. Embolization with metallic coils or microcoils is successful, but it depends on the anatomy, the size of the arterial lesion, and the technical ability to place selectivity or superselectivity catheters or microcatheters [1]; also NBCA has been successfully used to treat IEA pseudoaneurysm [24]. US-guided probe compression may be useful for initial management of the pseudoaneurysms, but it may not be adequate if the pseudoaneurysm is deep seated either secondary to a large haematoma or it has a wide neck [15]; pain and discomfort at the compression site, the longtime compression (30–50 min), and incomplete occlusion constitute drawbacks [3, 4].…”

“…US-guided probe compression may be useful for initial management of the pseudoaneurysms, but it may not be adequate if the pseudoaneurysm is deep seated either secondary to a large haematoma or it has a wide neck [15]; pain and discomfort at the compression site, the longtime compression (30–50 min), and incomplete occlusion constitute drawbacks [3, 4]. Ultrasonographic-guided thrombin injection is simple, safe, and quick to perform, painless and extremely effective, but the risk of thrombosis of patent artery because of the leakage of thrombin into the supply artery should be considered [1]. Spontaneous thrombosis has been reported after conservative management; the authors believe that the rise of intracompartimental pressure caused by hematoma was enough to achieve thrombosis [23].…”

“…They are therefore difficult to differentiate from simple haematomas, which can also present as tender masses [1]. Epigastric vassels are usually located in the area between 4 and 8 cm from the midline [28]; clinical suspicions for an IEA pseudoaneurysm should be raised when any patient presents with a painful abdominal wall mass <8 cm from either side of midline whether or not is found to be pulsatile [18].…”

“…The treatment options include surgery with excision and ligation of IEA, percutaneous embolization with placement of metallic coils or with N-butyl cyanoacrylate (NCBA), percutaneous thrombin injection, sonographic-guided compression, and conservative treatment [1–25]. …”