Abstract
BackgroundPseudoaneurysm of a vesical artery is an extremely rare iatrogenic complication; however, it may cause fatal haematuria.Case presentationA 21-year-old Arab Jordanian male had multiple optical urethrotomies for an iatrogenic urethral stricture after he had rectal surgery for Hirschsprung’s disease at the age of 2 years. During one of his admissions to the Emergency Room (ER) with urinary retention, an attempt at suprapubic catheter insertion was complicated by massive bleeding at the insertion site of the catheter. Abdominal exploration showed a distended urinary bladder with clots and bleeding seen at the bladder neck that was controlled with multiple sutures. The patient rebled again two times; the first was controlled with cystoscopy and cautery for a pulsatile bleeder seen at the bladder neck. The second time, the patient required blood transfusion of three units of packed red blood cells. Angiography was performed, and a pseudoaneurysm at the base of the urinary bladder from the inferior vesical artery was diagnosed, which was controlled by embolization.ConclusionPulsatile bladder haemorrhage following urological intervention is suggestive of pseudoaneurysm or arteriovesical fistula, and angiography with embolization is recommended.
Highlights
Pseudoaneurysm of a vesical artery is an extremely rare iatrogenic complication; it may cause fatal haematuria.Case presentation: A 21-year-old Arab Jordanian male had multiple optical urethrotomies for an iatrogenic urethral stricture after he had rectal surgery for Hirschsprung’s disease at the age of 2 years
Pulsatile bladder haemorrhage following urological intervention is suggestive of pseudoaneurysm or arteriovesical fistula, and angiography with embolization is recommended
Our patient had traumatic suprapubic catheter insertion that penetrated through the posterior bladder wall, inducing massive bleeding and pseudoaneurysm formation secondary to injury to the inferior vesical artery at the base of the bladder
Summary
A pseudoaneurysm, known as a false aneurysm, is leakage of arterial blood from an artery into the surrounding tissue with continuous communication between the originating artery and the resultant adjacent cavity. After detailed visualization of both ureteric orifices, bleeding was controlled with multiple sutures followed by insertion of a suprapubic catheter and a Foley catheter for ten days. Eleven days after his discharge, the patient returned to the ER with gross haematuria. Cystoscopy revealed blood oozing at the bladder neck; electrocoagulation was successful in controlling his bleeding (Figure 1) One week later, he came to the ER with gross haematuria; a 3-way Foley catheter was inserted and kept on continuous irrigation with normal saline; he received three units of packed red blood cells; after two days, he failed conservative treatment, and bleeding persisted. Selective embolization of the feeding artery led to immediate control of bleeding (Fig. 2)
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