Zoe Jones, Muhammad Ali A Rana*, Mark Langsfeld and John Marek
Division of Vascular Surgery, University of New Mexico School of Medicine, USAFulltext PDF
A wide variety of clinical presentations of complicated iliac arterial aneurysms is documented; however, iliorectal fistula in this setting has not been reported previously. We present a case of an 88-year-old gentleman who presented with massive lower gastrointestinal hemorrhage secondary to rupture of a left common iliac aneurysm with iliorectal fistula. Given the severe shock, patient was treated with endovascular exclusion of the aneurysm achieved with a percutaneous left common to external iliac artery stent-graft and embolization of internal iliac artery. Definitive repair was performed after resuscitation for 72 hours. This included a cross-femoral bypass followed by laparotomy, explantation of stent graft, endoaneurysmorrhaphy, and rectosigmoidectomy with end colostomy. Patient recovered well and over 18 month follow-up has had no complications. In conclusion, primary iliac aneurysms can rarely present with enteric and urological erosions or fistulas resulting in life threatening hemorrhage. Temporizing endovascular therapy despite the contaminated field can be life-saving.
Jones Z, Rana MAA, Langsfeld M, Marek J. Staged Endovascular and Open Surgical Management of a Ruptured Common Iliac Artery Aneurysm Presenting with Ilio-Rectal Fistula and Hemorrhagic Shock. Clin Surg. 2016; 1: 1156.