Curfman Karleigh R, Shuman Mieka P, Gorman Kimberly M, Schrock Wesley B, Meade Paul G
Department of General Surgery, Duke LifePoint Conemaugh Memorial Medical Center, Johnstown, PA, USA.
Department of Trauma, Duke LifePoint Conemaugh Memorial Medical Center, Johnstown, PA, USA.
Am J Case Rep. 2020 Aug 26;21:e924529. doi: 10.12659/AJCR.924529.
BACKGROUND 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.
假性动脉瘤是一种已知的病理情况，通常在血管壁破裂导致血肿形成后被识别。尽管假性动脉瘤很常见，但发生在直肠上动脉部位极为罕见，文献中仅记载过7次，且可能极其危险。患者可能出现模糊的腹部不适、疼痛、胃肠道出血及血肿形成，并可能进展为与血容量不足相关的血流动力学不稳定。这种现象需要迅速识别、患者管理以及稳定病情，以取得理想结果并将发病率和死亡率降至最低。病例报告：我们报告一例79岁男性病例，该患者因轻微创伤后出现胃肠道出血，被诊断为腹膜后血肿。尽管他病情稳定并出院，但直到第二次创伤事件导致症状加重且腹膜后血肿增大而再次就诊时，才完成对其病因性直肠上动脉假性动脉瘤的诊断和治疗。结论：直肠上动脉假性动脉瘤是一种罕见报道的现象，通常发生在创伤事件后。它可导致严重贫血、低血容量性休克、输血及其他严重后果。鉴于其位置及隐匿性，可能难以诊断。然而，一旦确诊，建议迅速治疗，为此已采用多种手术和血管内治疗方法以防止失血。
