Internal iliac artery aneurysmo-colonic fistula after endovascular stent-graft repair: a case report

Hypogastric Artery-Colonic Fistula after Coil Embolization of Left Hypogastric Artery Aneurysm

Coil migration into the colon is an extremely rare complication of aneurysm embolization and only three cases have been reported. Two of these cases were managed with resection of the involved colon and the remaining case was managed with serial imaging. We present a 70-year-old man who developed hematochezia 2 years after coil embolization of a ruptured left hypogastric artery aneurysm. The patient was successfully treated with diverting colostomy and endoscopic closure of the sigmoid colon defect. We present the only case report of the use of advanced endoscopy to treat endovascular coil migration.

Isolated internal iliac artery aneurysm causing rectal necrosis due to compression early after endovascular repair: A case report

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Many advantages of endovascular repair for aneurysms have been reported.

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The compression by aneurysms was not resolved early after endovascular repair.

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Rectal necrosis caused by residual aneurysms early after endovascular repair is rare.

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Aneurysm reduction and intestinal resection after embolization was a useful method.

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Embolization performed earlier assisted surgical decompression of aneurysms.

Introduction

Recently, endovascular repair has become the first-line treatment for internal iliac artery aneurysm (IIAA). However, rectal necrosis due to the compression of the residual IIAA early after endovascular repair is rare.

Presentation of case

We present a rare case of a huge, isolated left IIAA that severely compressed the rectum and ureter. The patient underwent emergency endovascular repair; however, rectal necrosis occurred 10 days later because the repair failed to shrink the size of the aneurismal sac.

Discussion

We hypothesize that the compression of the residual IIAA caused rectal necrosis. During open surgery, endovascular repair disrupted blood flow within the IIAA, which probably allowed for aneurysm dissection and residual hematoma removal.

Conclusion

Endovascular repair alone could not immediately release compression on the surrounding organs; however, open surgical removal of aneurysms after successful endovascular repair may be a useful option for IIAAs with compression of surrounding organs.