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

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References:

[1]	Bashar, K., et al. “Cerebral Hypoperfusion Secondary to Radiation Arteritis Presenting with Recurrent Syncope.” Case Reports, vol. 2014, no. jun23 1, 2014.
[2]	Baskar, Rajamanickam, et al. “Cancer and Radiation Therapy: Current Advances and Future Directions.” International Journal of Medical Sciences, vol. 9, no. 3, 2012, pp. 193-199.
[3]	Venkatesulu, Bhanu, et al. “Radiation-Induced Endothelial Vascular Injury.” JACC: BASIC TO TRANSLATIONAL SCIENCE, vol. 3, 24 Jan. 2018, pp. 563-572.
[4]	Modrall, J.gregory, and Javid Sadjadi. “Early and Late Presentations of Radiation Arteritis.” Seminars in Vascular Surgery, vol. 16, no. 3, 2003, pp. 209-214.
[5]	Protack, Clinton D., et al. “Radiation Arteritis: A Contraindication to Carotid Stenting?” Journal of Vascular Surgery, vol. 45, no. 1, 2007, pp. 110-117.
[6]	Zidar, Nina, et al. “Contribution to the Pathogenesis of Radiation-Induced Injury to Large Arteries.” The Journal of Laryngology & Otology, vol. 111, no. 10, 1997, pp. 988-990.
[7]	Walker, H. Kenneth, et al. Clinical Methods: the History, Physical, and Laboratory Examinations. Butterworths, 1990.
[8]	Delaney, Geoff, et al. “The Role of Radiotherapy in Cancer Treatment.” Cancer, vol. 104, no. 6, 2005, pp. 1129-1137.
[9]	Radiation Therapy Side Effects, www.smartdraw.com/common-cancer-treatments/examples/radiation-therapy-side-effects/.
[10]	Phang, P.terry, et al. “Techniques and Complications of Ileostomy Takedown.” The American Journal of Surgery, vol. 177, no. 6, 1999, pp. 463-466.
[11]	Poskus, Eligijus, et al. “Complications after Loop Ileostomy Closure: A Retrospective Analysis of 132 Patients.” Viszeralmedizin, S. Karger Verlag Für Medizin Und Naturwissenschaften GmbH, Aug. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4513804/.