American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
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American Journal of Medical Case Reports. 2020, 8(8), 229-231
DOI: 10.12691/ajmcr-8-8-3
Open AccessCase Report

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

Obed Kwame Agyei1, , 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

Pub. Date: May 06, 2020

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

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