Contained Rupture of a Large Colic Aneurysm

Abstract

<h3>Introduction and Objective</h3> Visceral artery aneurysms are infrequently encountered with a reported incidence of 0.1-1% in the general population. Despite their rarity, they can pose a significant threat to those afflicted; available literature suggests a 25-70% mortality rate with rupture. They predominantly occur in the splenic and hepatic arteries. However, colic aneurysms are exceptionally unusual, and their etiology is not completely understood. Genetic disorders and systemic conditions including polyarteritis nodosa, fibromuscular dysplasia, and infection have all been implicated. We present a case of a large colic aneurysm rupture as the first manifestation in an otherwise healthy patient with suspected rheumatological origin. <h3>Case Report</h3> A retrospective chart review was performed on a single patient in a tertiary care institution. A 54-year-old female was transferred to our facility with one week of progressively worsening abdominal pain, malaise and bilious emesis. She presented with tachycardia in the 110s and newly discovered hypertension at 176/104 requiring nicardipine titration. Her hemoglobin was stable at 10.4 g/dL with a normal vascular exam. Her abdomen was mildly distended but otherwise unremarkable. The patient did not take any medications, denied any smoking history or illicit drug use, and her only past surgery was a caesarean section. She underwent a computed tomographic angiography (CTA) scan of the abdomen significant for a large 7.7 cm aneurysm of the right colic artery with a collateral branch from an Arc of Buhler variant. Other aneurysms included a 1.2 cm celiac trunk aneurysm and a 4 mm left colic artery aneurysm. Additional vascular findings included beaded appearance of mesenteric vessels, pulmonary arteriovenous malformations, and a portovenous fistula. Due to the hemoperitoneum, symptomatic presentation, and large size, the patient underwent emergent embolization of her right colic aneurysm. Coil embolization was successfully performed as well to the Arc of Buhler. The patient's symptoms resolved, and she was discharged home after 4 days. <h3>Discussion</h3> Large colic aneurysms are extremely rare, and a presentation of rupture in the context of several other vascular aneurysms and malformations has not yet been described. Though most visceral aneurysms are discovered when symptomatic, their rupture can be life-threatening and the need for expeditious recognition and treatment is critical. CTA of the abdomen is invaluable, and most patients can be treated with coil embolization. Etiological workup can be performed when patients are stable and may involve a multidisciplinary approach.