Ureteral Obstruction Secondary to Inflammatory Isolated External Iliac Artery Aneurysm

Abstract

Introduction replacement of the external iliac artery and ureterolysis was performed. Extrinsic obstruction of the ureter is a common uroMicroscopic examination of the fibrotic tissue revealed a ‘‘Perianeurysmal retroperitoneal fibrosis’’. logical problem in which the diagnosis may be difficult to establish. Isolated iliac aneurysm is uncommon and Convalescence was uneventful. often gives rise to urinary tract obstruction. It should be considered when performing differential diagnosis of extrinsic ureteral obstruction. We report one patient Discussion with right hydroureteronephrosis secondary to extrinsic ureteral trapping due to inflammatory isolated Inflammatory iliac aneurysms are uncommon. The external iliac aneurysm. incidence of isolated iliac artery aneurysm is 1.9% and that of isolated internal iliac aneurysm is only 0.5% of abdominal aortic aneurysm. Case Report Patients with iliac artery aneurysms are most likely to present with urological manifestations. Isolated A 49-year-old man was admitted because of right iliac aneurysm often gives rise to urinary tract obinguinal pain. Physical examination was unstruction. remarkable. Laboratory investigations revealed an ESR Rarely external iliac artery aneurysms may cause value of 54 mm/h. Excretory urography demonstrated ureteral obstruction. The ureters may be obstructed a right hydroureteronephrosis. Retrograde pyeloureither by direct compression of the aneurysm or by eterography revealed a right hydroureteronephrosis entrapment of the ureter in fibrotic process, which with lower ureteral stenosis. Computerised tomomay be perianeurysmal immediately or more extensive graphy (CT) of the abdomen confirmed a right iliac in the retroperitoneum, resembling idiopathic reartery aneurysm of 4 cm in length and 2 cm in diameter troperitoneal fibrosis. The pathology of this fibrotic and an encased right ureter. process is characterised by proliferation of fibrous At exploration, an isolated aneurysm of the right tissues with inflammatory cell infiltration. There are external iliac artery, 4 cm in length, and entrapment two basic explanations for the development of perof the right ureter in perianeurysmal fibrosis was ianeurysmic fibrosis and retroperitoneal scarring. One observed. Resection of the aneurysm with Dacron graft is that small leaks develop at the weakest points of the aneurysm. After these seal, a retroperitoneal inflammatory reaction ensues and results in scarring ∗ Corresponding author: Burak Kocak, Guleryuz Sok. No: 4/3 Y. that may extend laterally to encase and subsequently Ayranci 06550 Ankara, Turkey. Tel: +90-532-3451272, Fax: +90-3123116351, E-mail: kocak@doctor.com obstruct the ureter. The second explanation relates to