PMC6661381_01
Initial contrast-enhanced CT findings.. (a) An isolated internal iliac artery aneurysm (IIAA; maximum diameter, 90 mm) occupying the pelvic cavity.. (b) Bilateral hydronephrosis is observed (red arrows), suggesting ureteral obstruction due to the IIAA.. (c) The rectum is compressed by the aneurysm, resulting in a narrowing (yellow arrows indicate rectum).
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CT confirmed the presence of a large and isolated left IIAA measuring 90 mm in diameter (Fig. 1). CT images revealed bilateral hydronephrosis along with the compression of the rectum by the IIAA (Fig. 2).
Findings of endovascular repair.. (a) Selective angiography of the left internal iliac artery. Distal to the aneurysm, the outflow vessel is slightly bifurcated (red arrow).. (b) Embolization with AVP was performed proximal to the internal iliac artery (yellow arrow indicates inflow vessel) and distal to bifurcation of the outflow vessel (red arrows).
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CT confirmed the presence of a large and isolated left IIAA measuring 90 mm in diameter (Fig. 1). CT images revealed bilateral hydronephrosis along with the compression of the rectum by the IIAA (Fig. 2).
CT findings 10 days after endovascular repair.. The rectum is more severely compressed by the aneurysm than before endovascular repair (red arrows).. The aneurysm wall was dissected as indicated during open surgery (yellow dotted line).
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Therefore, the surgeons decided to resect the lesion; however, owing to strong adhesion between the aneurysm and the rectum, incising through the IIAA wall was deemed necessary (Fig. 3).
Urethrography performed 18 days after the open surgery.. The contrast agent injected from the right ureteral catheter is discharged from the rectum (red arrows). The contrast agent can also be seen leaking into the residual aneurysm (yellow arrows).
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Although a vesicorectal fistula developed 18 days after the open surgery (Fig. 4), there was no sign of infection, and the fistula was left untreated.