External iliac pseudoaneurysm ruptured into non-functioning intrarenal allograft abscessed mass

Abstract

A 49-year-old woman was referred to our hospital with severe anaemia due to haemorrhage from a left lower abdominal open wound. Her medical history included haemodialysis because of chronic nephritis at age 28. She received a first renal graft in the right iliac fossa from her mother at age 29 and lost the graft function one and a half years later. She had a second renal graft in her left iliac fossa from a cadaveric donor at age 31. End-to-side anastomoses between the left external iliac vessels and graft ones were performed. Eleven years later, she lost the second graft function because of cyclosporine nephropathy and chronic allograft rejection diagnosed by episode biopsy. Seven years after the loss of allograft function and discontinuation of the immunosuppressant, she was admitted to the hospital where she had received grafts, with left lower abdominal pain and swelling after frequent episodes of cystitis. Computed tomography (CT) scanning showed an intra-renal-allograft mass (Figure 1). She underwent left lower abdominal laparotomy and drainage from the intra-renal-allograft abscessed mass. Cultures taken from the mass grew Escherichia coli, which was treated with antibiotics. Five months later, she was admitted to our hospital with a pulsatile mass at her left lower abdomen. The CT scanning demonstrated a large mass with enhancing central dual lumens (Figure 2). Diagnostic angiography confirmed the presence of dual lumen pseudoaneurysms from the left external iliac artery (Figure 3). Fig. 1. Enhanced CT scan revealed a capsulated intra-renalallograft and subcutaneous abscessed mass seven years after the loss of allograft function.