Inferior epigastric artery pseudoaneurysms

Inferior Epigastric Artery Pseudoaneurysm Following Laparoscopic Appendectomy

An inferior epigastric artery pseudoaneurysm is an exceptionally rare occurrence. Formation of an inferior epigastric artery pseudoaneurysm can be seen following surgical intervention and is more common after laparoscopy. A sixty-eight-year-old male presented with a right upper quadrant bulge at his incision site two months following laparoscopic appendectomy. The patient reported sudden onset of a non-reducible bulge at a 5 mm trocar incision site with minimal pain and without obstructive symptoms. Computed tomography of his abdomen and pelvis with intravenous contrast revealed a 4.2 cm pseudoaneurysm with peripheral thrombosis within the right inferior epigastric artery. The patient subsequently underwent open exploration with the evacuation of pseudoaneurysm thrombus and ligation of arteriovenous fistula. The patient recovered well without complication from pseudoaneurysm. Inferior epigastric artery pseudoaneurysm following any laparoscopic procedure is rare. This case highlights the importance of understanding the abdominal wall anatomy and its vascular supply to avoid such injury. We present this case to bring light to this rare occurrence and to highlight the importance of proper trocar placement during any laparoscopic procedure.

S, T.S. S, Chordia DA. Pseudoaneurysm of the Inferior Epigastric Artery Following Laparoscopic Extended Totally Extraperitoneal Repair for Inguinal Hernia

We hereby report a rare case of pseudoaneurysm of the left Inferior epigastric artery following extended totally extraperitoneal (e-TEP) repair for bilateral inguinal hernia. The patient developed swelling and pain in the lower abdomen one month following surgery. He was diagnosed to have a pseudoaneurysm of the left inferior epigastric artery with significant collection in the retro rectus plane. The pseudoaneurysm was thrombosed using Thrombin injection under ultrasound guidance. He was subsequently taken up for laparoscopic pseudo aneurysm excision with hematoma evacuation and ultrasound-guided transfascial ligation of the inferior epigastric artery with mesh explantation. The pseudoaneurysm was successfully treated and at follow-up, the patient’s symptoms were resolved.

Inferior epigastric artery pseudoaneurysm following abdominal paracentesis in a patient with chronic kidney failure: A case report and review of literature

Inferior epigastric artery (IEA) pseudoaneurysm is a rare complication following abdominal wall procedures near the artery. This is a case of inferior epigastric artery pseudoaneurysm after therapeutic paracentesis for large-volume ascites caused by chronic kidney failure. The patient was operated on, and the artery was ligated.

A Pseudoaneurysm of Aberrant Right Subclavian Artery Caused by Esophageal Stent Placement Because of Esophageal Stricture After Endoscopic Submucosal Dissection

A 67-year-old man who received endoscopic submucosal dissection for an early squamous esophageal cancer was hospitalized for dysphagia. The mucosal defect was over three quarters of the circumference, and the distal edge of the resection scar formed the stenosis after 8 months. After experiencing conservative treatment, probe expansion, and esophageal stent placement, the symptom of deglutition disorder in the patient was improved, but persistent hemorrhage and progressive anemia occurred in the short term. An enhanced neck and chest computed tomography (CT) showed a contrast agent leaked from the aberrant right subclavian artery to the esophagus. A pseudoaneurysm of the aberrant right subclavian artery and subclavian artery-esophageal fistula were diagnosed by CT angiography. Although false aneurysms developing after iatrogenic injury and trauma have been reported, those caused by esophageal stent placement because of esophageal stricture after endoscopic submucosal dissection have not. When persistent hemorrhage and progressive anemia develop after esophageal stent placement, an enhanced CT should be performed to exclude the false aneurysm.

Percutaneous Gastrostomy Tube Placement: Recognizing When Things Go Wrong

Percutaneous radiologic gastrostomy is a commonly performed, minimally invasive procedure for long-term enteral access in patients with a variety of conditions. Compared with other methods, it is less invasive, less costly, and safe, with a high technical success rate. The risk of complications is low, and most require only conservative management. Early, accurate diagnosis of more severe complication is crucial, as these may require prompt intervention. Therefore, radiologists should understand the imaging features, clinical presentation, and management of gastrostomy-related complications. This article will review the indications for long-term enteral access, discuss the available methods, summarize the percutaneous radiologic technique, and highlight the associated complications from gastrostomy placement.

Double direct hernia, triple indirect hernia, double Pantaloon hernia (Jammu, Kashmir and Ladakh Hernia) with anomalous inferior epigastric artey: Case report

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First kind of case report in literature.

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A unique case with double direct and triple indirect type of inguinal hernia.

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Named as Jammu Kashmir and Ladakh Hernia.

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Inferior epigastric artery may traverse an anomalous course in inguinal canal.

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Presence of multiple hernia sacs ,if undetected, is risk for recurrence.

Introduction

Double direct and triple indirect type hernia in unilateral inguinal hernia is unique. Anomaly of pathway traversed by inferior epigastric artery is always of surgical importance. Meticulous exploration of the groin is mandatory for diagnosis of rare hernia.

Case report

A 46 year old male presented with the right groin swelling. An inguinal hernia having two direct types separated by anamalous inferior epigastric artery and three indirect types of hernia were present. There was one bubonocele and two funicular types of indirect type of hernia present on the single cord. Anamalous inferior epigastric artery lying superficially at midpoint of inguinal canal was buttresed in the posterior wall to prevent its entrapping in mesh. Individual ligation of the indirect sacs and Lichtenstein repair was done.

This is first kind of unique case report with the new type of hernia reported in the English literature after searching Pubmed, Medline, Google Scholar and Embase database. This new hernia, Double Pantaloon hernia, as a mark of respect and unity, is named after its State of origin, “Jammu, Kashmir and Ladakh” so called as “Jammu Kashmir and Ladakh Hernia”.

Conclusion

Double direct and triple indirect type hernia in a unilateral inguinal hernia is unique. Presence of multiple hernia sacs in the inguinal hernia is a risk for recurrence, if not detected. Inferior epigastric artery in inguinal canal may traverse an aberrant course.