Li F, Zhao B, Liu YQ, Chen GQ, Qu RF, Xu C, Long Z, Wu JS, Xiong M, Liu WH, Zhu L, Feng XL, Zhang L. Hematochezia due to rectal invasion by an internal iliac artery aneurysm: A case report. World J Clin Cases 2024; 12(11): 1980-1989 [PMID: 38660556 DOI: 10.12998/wjcc.v12.i11.1980]
Corresponding Author of This Article
Lei Zhang, MD, PhD, Professor, Department of General Surgery, Chongqing General Hospital, No. 118 Xingguang Avenue, Liangjiang New District, Chongqing 401147, China. zhangleicgh@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Apr 16, 2024; 12(11): 1980-1989 Published online Apr 16, 2024. doi: 10.12998/wjcc.v12.i11.1980
Hematochezia due to rectal invasion by an internal iliac artery aneurysm: A case report
Fang Li, Bin Zhao, Yong-Qiang Liu, Guo-Qing Chen, Rong-Feng Qu, Chao Xu, Zhui Long, Jin-Song Wu, Mao Xiong, Wei-Hang Liu, Li Zhu, Xiao-Ling Feng, Lei Zhang
Fang Li, Bin Zhao, Yong-Qiang Liu, Guo-Qing Chen, Rong-Feng Qu, Chao Xu, Zhui Long, Jin-Song Wu, Mao Xiong, Wei-Hang Liu, Li Zhu, Xiao-Ling Feng, Lei Zhang, Department of General Surgery, Chongqing General Hospital, Chongqing 401147, China
Co-first authors: Fang Li and Bin Zhao.
Author contributions: Li F and Zhao B contributed equally to this work as co-first authors; Li F and Zhao B provided patient information and wrote the manuscript; Qu RF and Zhu L conceived the manuscript; Liu YQ and Feng XL collected the data; Chen GQ and Liu WH consulted the treatment plan; Long Z and Wu JS prepared histopathological examination and illustrations; Xiong M and Xu C reviewed the topic presentation, structure of the manuscript, illustrations, and photographs; Zhang L obtained resources and reviewed and edited the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed consent was obtained from the patient for the publication of this case report and any accompanying images.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lei Zhang, MD, PhD, Professor, Department of General Surgery, Chongqing General Hospital, No. 118 Xingguang Avenue, Liangjiang New District, Chongqing 401147, China. zhangleicgh@163.com
Received: January 22, 2024 Peer-review started: January 22, 2024 First decision: February 28, 2024 Revised: March 1, 2024 Accepted: March 21, 2024 Article in press: March 21, 2024 Published online: April 16, 2024 Processing time: 80 Days and 5.7 Hours
Abstract
BACKGROUND
This case report presents the rare occurrence of hematochezia due to an internal iliac artery aneurysm leading to an arterioenteric fistula, expanding the differential diagnosis for gastrointestinal bleeding. It emphasizes the importance of considering vascular origins in cases of atypical hematochezia, particularly in the absence of common gastrointestinal causes, and highlights the role of imaging and multidisciplinary management in diagnosing and treating such unusual presentations.
CASE SUMMARY
A 75-year-old man with a history of hypertension presented with 12 d of hematochezia, experiencing bloody stools 7-8 times per day. Initial computed tomography (CT) scans revealed an aneurysmal rupture near the right internal iliac artery with suspected hematoma development. Hemoglobin levels progressively decreased to 7 g/dL. Emergency arterial angiography and iliac artery-covered stent placement were performed, followed by balloon angioplasty. Despite initial stabilization, minor rectal bleeding and abdominal pain persisted, leading to further diagnostic colonoscopy. This identified a neoplasm and potential perforation at the proximal rectum. An exploratory laparotomy confirmed the presence of a hematoma and an aneurysm invading the rectal wall, necessitating partial rectal resection, intestinal anastomosis, and ileostomy. Postoperative recovery was successful, with no further bleeding incidents and normal follow-up CT and colonoscopy results after six months.
CONCLUSION
In cases of unusual gastrointestinal bleeding, it is necessary to consider vascular causes for effective diagnosis and intervention.
Core Tip: Lower gastrointestinal bleeding (LGIB) is one of the primary causes of morbidity and mortality in middle-aged and elderly individuals. Hematochezia is a primary manifestation of LGIB and is often associated with ulcers, tumors, and vascular malformations. Here, we report a very rare etiology, which can be attributed to an internal iliac artery aneurysm invading the proximal rectum causing an arterial fistula to the rectum, resulting in massive hematochezia. We hope that this case serves as a reminder that hematochezia may stem from less common causes.
