Abstract
The occurrence of an isolated internal iliac artery aneurysm with the complication of a rectal fistula is very rare ; however, surgeons should take care of massive hemorrhage. An 81-year-old-male complained of bloody stool 5 months ago. Upper and lower endoscopies did not show any obvious evidence of hemorrhage. The enhanced CT image showed the presence of an isolated internal iliac arterial aneurysm, approximately 8 cm in size. Transcatheter arterial embolization (TAE) was performed to prevent rupture of the aneurysm. The patient complained of right lower abdominal and femoral pain. Through CT, it was found that there was abnormal gas in the aneurysm. Administration of an rectal enema showed the leakage of contrast media from the right wall of the rectum to the aneurysm around vascular embolization coils. Since CT images showed that the coil dropped out into the rectum, the patient received emergency surgery. Ligation of the roots of the right internal iliac artery was performed and the fistula was divided. A rectal resection was performed, including removal of the fistula. An anastomosis was performed and a temporary ileostomy was created. The cavity of the aneurysm was washed and drained. There were no post-operative complications. A half-year later, the ileostomy was closed and there was no recurrence of a fistula for 3 years. TAE alone would be insufficient to treat aortic aneurysms with the complication of enteric fistulae. Therefore, in such cases, surgery should be the first choice for treatment.
