Traumatic Pseudoaneurysm of the Ileal Artery

Abstract

A 35-year-old man was admitted to our hospital after being involved in a traffic accident on November 19, 2000. A contrast-enhanced CT scan of his abdomen revealed a small amount of ascites. On the third post-admission day, his temperature rose to 39 degrees centigrade and his serum amylase level became elevated. We diagnosed the patient as having an intestinal perforation with general peritonitis and performed a laparotomy. Since the mesentery of the ileum was injured and the ileum was necrotic, a partial ileotomy and ileostomy were performed. On the 21st post-operative day, his temperature rose once again. CT and intravenous digital subtraction angiography examinations demonstrated a pseudoaneurysm in a branch of the superior mesenteric artery (SMA). Previous reports indicate that traumatic pseudoaneurysm of an SMA branch is relatively rare. To date, six cases have been reported. We decided not to treat the traumatic pseudoaneurysm of the ileal artery using transcatheter arterial embolization (TAE), Instead, we treated the patient surgically to prevent any injury to the pseudoaeurysm's wall, which had been weakened by the spread of inflammation and ileum necrosis. In retrospect, careful treatment of the injured mesentery to stop bleeding during the first operation could have prevented the formation of the pseudoaneurysm.