|IMAGES IN VASCULAR SURGERY
|Year : 2016 | Volume
| Issue : 3 | Page : 109-111
Rare Cause of Colostomy Bleeding: A Parastomal Pseudoaneurysm
Vijay Thakore, Jayesh Patel, Sumit Kapadia
Department of Vascular and Endovascular Surgery, Angio Care Vins Hospital, Baroda, Gujarat, India
|Date of Web Publication||25-Jul-2016|
Dr. Jayesh Patel
Department of Vascular and Endovascular Surgery, Angio Care Vins Hospital, Baroda, Gujarat
Source of Support: None, Conflict of Interest: None
Patient diagnosed with rectal cancer underwent low anterior resection with protective sigmoid colostomy. He developed intractable bleeding from colostomy site on 10th post-op day. He went into haemorrhagic shock, resuscitated with massive blood transfusion. Emergent CT angio of abdomen showed a well defined, bilobed, fusiform dilated sac with smooth homogenous contrast opacification seen in the operative stomal site with a small feeding artery arising from left iliac artery? possibly an aneurysmal sac with feeding artery. The patient was successfully treated with an endovascular approach.
Keywords: Angioembolization, colostomy bleeding, pseudoaneurysm
|How to cite this article:|
Thakore V, Patel J, Kapadia S. Rare Cause of Colostomy Bleeding: A Parastomal Pseudoaneurysm. Indian J Vasc Endovasc Surg 2016;3:109-11
| Introduction|| |
A pseudoaneurysm is defined as a pulsating, encapsulated hematoma in communication with the lumen of a ruptured vessel. Pseudoaneurysms are caused by trauma, tumors, infection, vasculitis, atherosclerosis and iatrogenic complication. We report a patient with rupture pseudoaneurysm of deep circumflex artery, which led to hemorrhagic shock and was treated successfully with angioembolisation.
| Case Report|| |
A 45-year-old male diagnosed to have rectal cancer underwent anterior resection with protective sigmoid colostomy. He developed intractable bleeding from the colostomy site on the 10th postoperative day leading to hemorrhagic shock which required massive blood transfusion.
Emergent computed tomography angiography of the abdomen showed a well-defined, bilobed, fusiform dilated sac with smooth homogenous contrast opacification in the stomal site with a small feeding artery arising from the left iliac artery [Figure 1] and [Figure 2].
A right femoral artery access was obtained. A 6 Fr crossover sheath was placed and catheter angiography of the left iliac artery was performed [Figure 3]. A pseudoaneurysm arising from deep circumflex branch of external iliac artery was detected [Figure 4], [Figure 5], [Figure 6]. A left internal mammary artery catheter was placed at the ostium of the deep circumflex artery. With a microcatheter placed in the feeder artery close to aneurysm sac, 3 mm × 4 cm and 3 mm × 3 cm microcoils were deployed [Figure 7], [Figure 8], [Figure 9]. Fifty percent of histoacryl glue 0.5 cc was injected into the feeder artery. This resulted in successful emoblization of bleeding pseudoaneurysm [Figure 10].
| Discussion|| |
Pseudoaneurysms can be life threatening due to rupture and bleeding. Therefore, they are considered an emergency and need to be diagnosed accurately and quickly. Also, prompt treatment using surgical, medical, and endovascular techniques is essential. Moreover, pseudoaneurysms are not rare, and various conditions can cause a pseudoaneurysm in all the cardiovascular systems. Knowledge of the various appearances of pseudoaneurysms and of the proper management is essential to prevent a catastrophic outcome in these cases. Endovascular approach is a very good option for diagnostic as well as therapeutic purpose in such conditions.
| Conclusion|| |
A parastomal pseudoaneurysm is extremely rare.,,,, There are no reports on endovascular management of such a complication following colostomy.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]