Usefulness of Computed Tomographic Angiography Using a Multidetector Computed Tomographic Scanner in the Diagnosis and Determination of the Therapeutic Strategy for Traumatic Ileal Pseudoaneurysm

Abstract

The patient was an 86-year-old woman who suffered a pelvic fracture in a motor vehicle accident. Dynamic CT performed 12 hours after the injury using a multidetector CT (MDCT) scanner, revealed an aneurysm in the mesentery. CT angiography showed that the aneurysm was located in the peripheral region of the superior mesenteric artery. She was diagnosed as having a traumatic ileal pseudoaneurysm which was gradually increasing in size. At emergency laparotomy the injured intestine and the involved mesenteric artery were resected and anastomosed in an end-to-end fashion. Generally, the treatment of choice for this disorder is either surgery or transcatheter arterial embolization (TAE). We chose surgical treatment because the CT angiography demonstrated that the aneurysm was close to the intestine and thus we considered that TAE could cause intestinal ischemic necrosis. CT angiography using an MDCT scanner is a noninvasive diagnostic tool that allows the localization of an aneurysm and provides morphological information. Therefore, it is very useful to determine the therapeutic strategy.