J Korean Soc Radiol.  2015 Jan;72(1):29-32. 10.3348/jksr.2015.72.1.29.

Traumatic Pseudoaneurysm of the Superior Rectal Artery with Recurrent Lower Gastrointestinal and Pelvic Extraperitoneal Bleeding: Importance of Pretreatment Recognition

• Kim KJ
• Seo JW
• Kim YS

• KMID: 1823931
• DOI: http://doi.org/10.3348/jksr.2015.72.1.29

Abstract

Traumatic pseudoaneurysm of the superior rectal artery is a rare cause of massive lower gastrointestinal bleeding. We reported a case of a 43-year-old male patient with pseudoaneurysm following a penetrating perineal wound. The patient had repeat massive lower gastrointestinal and pelvic extraperitoneal bleeding and was diagnosed as traumatic pseudoaneurysm of the superior rectal artery. To our knowledge, there are three case reports of traumatic pseudoaneurysm of the superior rectal artery treated by embolization. However, spontaneous regression occurred in the study subject after surgical hematoma removal, without any further pseudoaneurysm resection.

MeSH Terms

Adult
Aneurysm, False*
Arteries*
Hematoma
Hemorrhage*
Humans
Male
Wounds and Injuries

Figure

• 

  Fig. 1 Traumatic pseudoaneurysm of superior rectal artery in a 43-year-old male patient. A. Axial contrast enhanced CT scan on the day of trauma at a local hospital shows the pseudoaneurysm (arrow) as a saccular enhancing lesion located at the anterior wall of the rectum, measuring 1.5 cm. B. Follow-up CT scans on day 2 of trauma (next day after first surgery) show contrast leakage (long white arrow) from the pseudoaneurysm (not resected) surrounded by a hematoma in the posterior perivesical space. Drainage catheter tip (black arrow) is located in the rectovesical pouch and residual rectum stump (short white arrow) is collapsed. C. Volume rendered three-dimensional reformatted CT on day 2 of trauma shows a saccular pseudoaneurysm (long white arrow) resulting bleed upward (short white arrow). Foley catheter (F) is inserted into urinary bladder and a drainage catheter (D) is located in intraperitoneal and pelvic cavity. D. Follow-up coronal CT scans on day 4 of trauma (next day after second surgery) show a residual pseudoaneurysm (white arrow) as a small focal enhancing lesion in the anterior wall of the rectum, measuring 0.3 × 0.6 cm. E. Conventional angiography performed on day 17 of trauma shows no residual pseudoaneurysm on bilateral internal iliac and inferior mesenteric arteriograms.

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