TWO CASES OF INTERNAL ILIAC ANEURYSM PRESENTED WITH RECTAL BLEEDING-WITH SPECIAL REFERENCE TO CASES OF INTERNAL ILIAC ANEURYSM WITH INTESTINAL FISTULA-

Abstract

Two cases of internal iliac aneurysm with intestinal fistula presented with rectal bleeding are reported. A 79-year-old man was seen at the hospital because of rectal bleeding. Pelvic CT revealed a solitary right internal iliac aneurysm with the diameter of 8 cm as well as thrombus in the wall of the tumor with irregular gas figure. An operation was performed with a diagnosis of perforation of the aneurysm through the intestine, but closure of the fistula between the aneurysm and intetine was impossible because of severe adhesion. So the fistula was left intact and ligation of the internal iliac artery, resection of the aneurysmal wall, and intraaneurysmal drainage were performed. Postoperative course was uneventful without infection. Another patient, a 72-year-old man was seen at the hospital because of rectal bleeding. There was a previous history of undergoing an operation for a cancer of the sigmoid colon when an aneurysm 3cm in diameter in the left internal iliac artery was detected but it was left intact. CT after admission revealed the aneurysm dilated to 4.5cm in diameter and numerous dots gas figure in the thrombosis in the wall. The patient was suspected to have a fistula formation with the intestine and was scheduled for exploration. But the patient abruptly developed massive rectal bleeding and died of blood loss without any operation. Considering these conditions, it was inferred that the aneurysm might perforate the intestine. Only 14 cases of internal iliac aneurysm with intestinal fistula have been reported in Japan up to now.