Challenging differential diagnosis, Unusual or unexpected effect of treatment, Rare disease
Karleigh R. Curfman, Mieka P. Shuman, Kimberly M. Gorman, Wesley B. Schrock, Paul G. Meade
Department of General Surgery, Duke LifePoint Conemaugh Memorial Medical Center, Johnstown, PA, USA
Am J Case Rep 2020; 21:e924529
Available online: 2020-07-15
Pseudoaneurysms are a known pathology commonly recognized after disruption of the vascular wall leads to the development of a hematoma. Although pseudoaneurysms are common, occurrence in the location of the superior rectal artery is exceedingly rare, has been documented in the literature only 7 times, and can be extremely dangerous. Patients can present with vague abdominal complaints, pain, gastrointestinal bleeding, and development of hematomas, and can progress to hemodynamic instability related to hypovolemia. This phenomenon requires swift recognition and patient management, as well as stabilization, to achieve desired results and minimize morbidity and mortality.
CASE REPORT: We report the case of a 79-year-old man who presented after minor trauma with gastrointestinal bleeding and was diagnosed with a retroperitoneal hematoma. Although he was stabilized and discharged, conventional angiography diagnosing and treating his causative superior rectal artery pseudoaneurysm was not completed until a second traumatic event resulted in recurrent presentation with worsened symptoms and retroperitoneal hematoma enlargement.
CONCLUSIONS: Superior rectal artery pseudoaneurysm is a rarely-reported phenomenon, usually occurring after a traumatic event. It can lead to significant anemia, hypovolemic shock, blood transfusion, and other serious consequences. It can be difficult to diagnose given its location and obscurity. However, upon diagnosis, swift treatment is recommended, for which a variety of both surgical and endovascular approaches have been employed to prevent exsanguination.
Keywords: Aneurysm, False, Angiography, Anticoagulants, Hematoma, Retroperitoneal Space