Table of Contents  
IMAGES IN VASCULAR SURGERY
Year : 2016  |  Volume : 3  |  Issue : 3  |  Page : 109-111

Rare Cause of Colostomy Bleeding: A Parastomal Pseudoaneurysm


Department of Vascular and Endovascular Surgery, Angio Care Vins Hospital, Baroda, Gujarat, India

Date of Web Publication25-Jul-2016

Correspondence Address:
Dr. Jayesh Patel
Department of Vascular and Endovascular Surgery, Angio Care Vins Hospital, Baroda, Gujarat
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-0820.186724

Rights and Permissions
  Abstract 

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

How to cite this URL:
Thakore V, Patel J, Kapadia S. Rare Cause of Colostomy Bleeding: A Parastomal Pseudoaneurysm. Indian J Vasc Endovasc Surg [serial online] 2016 [cited 2020 Feb 27];3:109-11. Available from: http://www.indjvascsurg.org/text.asp?2016/3/3/109/186724


  Introduction Top


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 Top


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].
Figure 1: Computed tomography angiogram showing pseudoaneurysm

Click here to view
Figure 2: Computed tomography angiography

Click here to view


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].
Figure 3: External iliac artery

Click here to view
Figure 4: Selective cannulation of feeder artery

Click here to view
Figure 5: Pseudoaneurysm

Click here to view
Figure 6: DSA showing pseudoaneurysm

Click here to view
Figure 7: Distal to the aneurysm

Click here to view
Figure 8: Distal coil

Click here to view
Figure 9: Proximal and distal coil

Click here to view
Figure 10: End result

Click here to view



  Discussion Top


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 Top


A parastomal pseudoaneurysm is extremely rare.[1],[2],[3],[4],[5] There are no reports on endovascular management of such a complication following colostomy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Springer C, Mohammed N, Alba S, Theil G, Altieri VM, Fornara P, et al. Laparoscopic radical cystectomy with extracorporeal ileal neobladder for muscle-invasive urothelial carcinoma of the bladder: Technique and short-term outcomes. World J Urol 2014;32:407-12.  Back to cited text no. 1
    
2.
Huang WY, Huang CY, Chen CA, Hsieh CY, Cheng WF. Ruptured pseudoaneurysm of the external iliac artery in an advanced cervical cancer patient treated by endovascular covered stent placement. J Formos Med Assoc 2008;107:348-51.  Back to cited text no. 2
    
3.
Sueyoshi E, Sakamoto I, Nakashima K, Minami K, Hayashi K. Visceral and peripheral arterial pseudoaneurysms. AJR Am J Roentgenol 2005;185:741-9.  Back to cited text no. 3
    
4.
Huang J, Lin T, Liu H, Xu K, Zhang C, Jiang C, et al. Laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer: Oncologic results of 171 cases with a median 3-year follow-up. Eur Urol 2010;58:442-9.  Back to cited text no. 4
    
5.
Ricciardi E, Di Martino G, Maniglio P, Schimberni M, Frega A, Jakimovska M, et al. Life-threatening bleeding after pelvic lymphadenectomy for cervical cancer: Endovascular management of ruptured false aneurysm of the external iliac artery. World J Surg Oncol 2012;10:149.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
   Abstract
  Introduction
  Case Report
  Discussion
  Conclusion
   References
   Article Figures

 Article Access Statistics
    Viewed1188    
    Printed28    
    Emailed0    
    PDF Downloaded40    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]