Rupture of an Iliac Artery Pseudo-aneurysm into a Ureter

Case Report Fig. 1. CT scan of the pelvis of a 50-year-old woman with a 2-week history of macroscopic haematuria. No aneurysms is demonstrated. A 50-year-old woman was referred to the department was found. During this procedure the ureter was of Urology with a 2-week history of macroscopic haemaccidentally divided and was repaired over a doubleaturia. She had a past history of hypertension and she J catheter. The patient then made a good recovery. had an aortobi-ilac artery bypass when she was 40 However, 6 months later she was readmitted again years old because of severe ischaemia due to smoking. with a (5-day) history of macroscopic haematuria. The On admission she was pale and her blood pressure catheter was removed and pulsating haematuria was was 90/60mmHg. Haemoglobin was 3mmol/l (nornoticed from the left ureter. On examination of the mal range 7.0–10.0mml/l). Following resuscitation, abdomen, a 10×10cm pulsating mass was found in intravenous urography and ultrasound scanning the left iliac fossal. A CT scan showed a 10×15cm showed a left hydronephrosis and cystoscopy showed pseudoaneurysm in the left side of the pelvis (Fig. two perforations on the top of the bladder. A CT scan 2). At operation, a necrotic ureter was found in the confirmed these findings. No aneurysm was found pseudoaneurysm orignating from the anastomosis. A (Fig. 1). An emergency laparotomy was performed Dacron graft was anastomosed from the old graft and the bladder was opened but no explanation for to the femoral artery and a left nephrectomy was the haematuria was found. However, the left ureter performed. The patient made an uneventful recovery. was found to be firmly adherent to the left iliac artery at the level of the anastomosis to the graft. The left ureter was disected free but no fistula or aneurysm Discussion