Hypogastric artery aneurysm masquerading as an ovarian neoplasm

Uterine artery aneurysm mimicking pelvic sarcoma. A case report and review of literature. raslanwf@aramco.com.sa

We report a case of true uterine artery aneurysm in a 77-year-old diabetic woman, which was suspected radiologically as a pelvic sarcoma. The aneurysm was communicating with the atherosclerotic left uterine artery. Pelvic aneurysms carry the potential risk of massive intra-operative hemorrhage if the diagnosis was not established prior to operation.

Isolated hypogastric artery aneurysms

Iliac artery aneurysms are rare in the absence of concomitant abdominal aortic aneurysm (AAA), and isolated internal iliac (hypogastric) aneurysms in particular are extremely rare. From 1986 to 1997 we repaired 572 aortic and/or iliac artery aneurysms in 440 patients. Among these there were only seven hypogastric aneurysms and three of these occurred in the absence of, or remote to, AAA. Hypogastric aneurysms are difficult to diagnose, and large aneurysms are associated with significant morbidity and mortality due to compression of adjacent structures and a high rate of rupture. They pose technical challenges in repair because of their location deep in the pelvis and because it is difficult to gain distal control of the hypogastric artery and its branches. However, the technique of obliterative endoaneurysmorrhaphy has made repair of these aneurysms safe and straightforward. Moreover, this method, unlike percutaneous endovascular techniques, eliminates the compressive mass that is often associated with significant symptomatology. We report three isolated hypogastric aneurysms repaired over an 11-year period, illustrating the technique of proximal ligation and obliterative endoaneurysmorrhaphy, and review the literature on the topic.