Abstract
We report a case of pseudoaneurysm of the left internal iliac artery after intravesical Bacillus Calmette-Guerin (BCG) therapy for bladder cancer. A 75-year-old man was referred to us with lumbar pain and recurring fever. One year previously he was treated for bladder cancer with transurethral resection, followed by adjuvant intravesical BCG therapy lasting 11 months. Computed tomography scanning demonstrated a pseudoaneurysm and perianeurysmal inflammatory changes in the region of the left internal iliac artery. An emergency operation was performed under a diagnosis of impending rupture of the tuberculous left internal iliac arterial aneurysm. Because of the urinary tract stenosis, which was caused by the aneurysm, we inserted a ureteral stent preoperatively. We performed aneurysmectomy and femorofemoral cross over bypass. After 10 months of antituberculous chemotherapy, CT showed no recurrence of infectious aneurysm. Although intravesical BCG therapy is generally considered safe, serious complications including vascular complication have been reported. A mycotic origin should be considered when an aneurysm is discovered after BCG therapy. The prophylactic use of a ureteral stent in mycotic iliac arterial surgery may lead to minor complications.
