[Endovascular management of a ruptured pseudoaneurysm of a rectal artery]. / Tratamento endovascular de pseudoaneurismade uma artéria rectal em rotura.

ABSTRACT

A 22-years old male patient, with a history of renovascular hypertension, was evaluated in the emergency department for abdominal pain of acute onset, interpreted as acute appendicitis. During surgery, we identified an extensive haemoperitoneum which required conversion to laparotomy without identifying focal hemorrhage. A peri-operative angiography disclosed a parietal irregularity of the upper rectal artery, without active bleeding. The patient remained stable until the 15th postoperative day, when there was clinical deterioration and hemoglobin decrease. Angio-CT revealed the presence of an upper rectal artery pseudoaneurysm with an extensive retroperitoneal and organized hematoma. The patient was proposed for surgical correction which was not carried out due to extensive inflammatory and fibrotic changes, being referred for endovascular exclusion, performed by selective catheterization and coil embolization. The procedure went without complications. Catheterization was performed upstream and downstream of the pseudoaneurysm, with microcatheter, and embolization performed with coils. Control angiography showed no filling of the aneurysm. The patient remained asymptomatic after the procedure, with clinical and analytical stability. Inferior mesenteric artery primary pseudoaneurysms are rare but potentially fatal, with formal indication for treatment, given the risks of free rupture. The use of endovascular techniques allows a minimally invasive approach, with exclusion of the PA, with high rates of primary success. Doubts remain regarding the functionality of the involved organ and long-term recurrence rates; therefore high importance is given to proper follow-up of these patients.