Indian Journal of Vascular and Endovascular Surgery

IMAGES IN VASCULAR SURGERY
Year
: 2016  |  Volume : 3  |  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

Correspondence Address:
Dr. Jayesh Patel
Department of Vascular and Endovascular Surgery, Angio Care Vins Hospital, Baroda, Gujarat
India

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.



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;3:109-111


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 Apr 6 ];3:109-111
Available from: http://www.indjvascsurg.org/text.asp?2016/3/3/109/186724


Full Text

 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].{Figure 1}{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].{Figure 3}{Figure 4}{Figure 5}{Figure 6}{Figure 7}{Figure 8}{Figure 9}{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.[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

1Springer 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.
2Huang 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.
3Sueyoshi E, Sakamoto I, Nakashima K, Minami K, Hayashi K. Visceral and peripheral arterial pseudoaneurysms. AJR Am J Roentgenol 2005;185:741-9.
4Huang 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.
5Ricciardi 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.