Presentation
Rectal bleeding, drop in hemoglobin. Underwent EVAR 10 years earlier.
Patient Data
Status post aorto-bi-iliac stent graft placement.
Saccular aneurysm measuring 11.5x9.6x9.3 cm (LLxAPxCC) bulging out anteriorly from the inferior edge of the infrarenal abdominal aorta. Streaks of contrast material in the aneurysm, representing active bleeding, enlarging significantly between the arterial and portal venous scans.
Status post total gastrectomy and splenectomy.
Homogeneously enhancing ovoid structure in the pancreatic tail, most probably an intrapancreatic splenule.
Simple cortical and parapelvic renal cysts, including a large cortical cyst in the upper pole of the left kidney.
Mesenteric panniculitis.
Innumerable diverticula along descending and sigmoid colon.
Case Discussion
Admitted for workup for rectal bleeding and abdominal pain. CT angiography revealed an endoleak in a huge saccular aneurysm that was shown to be a type IIb endoleak, as several arteries were involved. Strangely enough, the endoleak occurred 10 years after stent-graft placement. The width of the aneurysm at the time of stent graft placement was 6.3 cm, compared to 11.5 cm on the present CT study.
Angiography demonstrated a patent inferior mesenteric artery (IMA) and lumbar artery. The patient underwent laparotomy, whereby a sacotomy was performed and the IMA and lumbar artery were ligated. The patient, a nonagenarian, recovered well from the operation and lived on for over a year.