A CASE OF ANEURYSM OF THE RIGHT COMMON ILIAC ARTERY RUPTURED INTO APPENDIX

Abstract

A case of aneurysm of the right common iliac artery with rupture into the appendix is reported.
A 69-year-old man with massive melena received emergency surgery during shock. Upon laparotomy, a firmly adhering egg-sized sclerotic aneurysm of the right common iliac artery ruptured into the body of the appendix. With the procedure of appendectomy and partial aneurysmectomy, he recovered. However, six months later massive melena with shock occurred again, and he underwent reoperation. The residual aneurysm of the rifht common iliac artery regrew and ruptured into the sigmoid colon. Although removal of the entire aneurysm and femoro-femoral bypass was done, he died three days after reoperation with renal failure.
Rupture of an abdominal aneurysm into the lower digestive tract is rare. This is considered the first case in Japan of a fistula between a common iliac aneurysm and the appendix. For the treatment of aneurysmo-lower intestinal fistula with massive melena, emergency operation consisting of the removal of the entire aneurysm and arterial reconstruction should be performed immediately to save the patient's life, rather than doing time-consuming diagnostic procedures.