Abstract
A 41-year-old woman was admitted to the hospital with bloody bowel discharge, nausea, and pain in the left lower abdomen. Abdominal computed tomography (CT) scan revealed dilatation of the small intestine and a retroperitoneal abscess due to penetration of the sigmoid colon into the retroperitoneal space. A long intestinal tube was inserted into the colon to achieve decompression by puncture drainage of the abscess. Partial sigmoidectomy and retroperitoneal debridement were performed after successful preoperative treatment for the ileus and the retroperitoneal abscess. The postoperative course was good. However, on the 13th day after the surgery, she suddenly presented with severe hemorrhage from the drain and developed hypotensive shock. Abdominal CT scan and angiography indicated rupture of the left external iliac pseudoaneurysm due to infection. Therefore, the following emergency procedures were performed : left external iliac aneurysmectomy, arterial reconstruction with a femoro-femoral cross over bypass using an autologous great saphenous vein graft, and extensive retroperitoneal debridement. The infection was well controlled after the emergency procedures, and blood flow into the left leg through the constructed bypass was maintained for 14 months after the operation. We achieved a favorable outcome for ruptured infected external iliac pseudoaneurysm by performing extra-anatomic reconstruction using an autologous graft.
