Right Common Iliac Artery Aneurysm Rupture presenting as Hematochezia due to Probable Radiation-induced Arteritis: A Case Report

Obed Kwame Agyei^1, , Rakesh Alva² and Heath McCullough³

¹Department of Internal Medicine Cone Health teaching affiliate UNC Chapel Hill Medical Center, Greensboro, USA

²Department of Critical Care Cone Health teaching affiliate UNC Chapel Hill Medical Center, Greensboro, USA

³Department of Radiology Cone Health teaching affiliate UNC Chapel Hill Medical Center, Greensboro, USA

Cite this paper

Obed Kwame Agyei, Rakesh Alva and Heath McCullough. Right Common Iliac Artery Aneurysm Rupture presenting as Hematochezia due to Probable Radiation-induced Arteritis: A Case Report. American Journal of Medical Case Reports. 2020; 8(8):229-231. doi: 10.12691/AJMCR-8-8-3

Abstract

Background: Hematochezia is a common presentation that typically indicates a lower gastrointestinal pathology. The differential diagnoses for lower GI bleed include malignancy, inflammatory bowel disease, hemorrhoids, diverticulosis, ischemic colitis, arterio-venous malformations etc. Rarely is a ruptured iliac artery associated with a lower GI bleed. Case Report: A 45-year-old woman with metastatic squamous carcinoma of the cervix status post External Beam Radiotherapy, High Dose Rate Brachytherapy, diverting loop ileostomy and takedown due to sigmoid perforation presented with acute onset hematochezia complicated by hemorrhagic shock and pulseless electrical activity arrest with Return of Spontaneous Circulation following volume resuscitation with crystalloids, blood products, CPR and epinephrine. Sigmoidoscopy revealed active bleeding at the recto-sigmoid junction. CT Aortography revealed right common iliac artery aneurysm rupture with contrast extravasation in the pelvis. She successfully underwent stenting of the right common iliac artery with cessation of contrast extravasation. Unfortunately, the patient died due to her complicated clinical course. Conclusion: Radiation arteritis can result in peripheral arterial disease, coronary artery disease, stroke, subdural hematoma and spontaneous arterial rupture. In the apropriate context, it carries a high mortality risk if missed. Clinicians should have high suspicion of radiation induced arterial injury in patients who have undergone radiotherapy.

Keywords

hematochezia, arteritis, radiation, rupture, loop ileostomy, External Beam Radiotherapy (EBRT), High Dose Rate (HDR) Brachytherapy, cancer

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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