Placenta Percreta Invading the Bladder Causing Exsanguinating Hemorrhage

We report a case of placenta percreta invading the urinary bladder that presented as gross hematuria. The patient had normal cystoscopic findings initially and other radiological investigations were reported as normal. However, she had catastrophic second hemorrhage and in spite of bilateral internal iliac artery ligation, hysterectomy and bladder closure with resuscitative measures, she could not be saved.     

Rupture of Internal Iliac Artery Aneurysm into the Bladder following Aortic Aneurysm Repair

This report describes a case of ruptured internal iliac artery aneurysm into the bladder after repair of an infrarenal abdominal aortic aneurysm. Aortic repair consisted of resection of the aneurysm followed by prosthetic interposition to reestablish arterial continuity. During the postoperative period, the patient had ischemia of left colon, which was successfully treated by the Hartmann procedure. A right internal iliac artery aneurysm measuring 50 mm in diameter was demonstrated by an abdominal CT scan during the initial hospitalization but was considered stable, since ultrasonography showed no change in diameter at 3 months and 1 year. The patient was lost from follow-up until 3 years later when he was hospitalized after rupture of the right iliac artery aneurysm, then measuring 120 mm in diameter, into the bladder. Surgical repair was undertaken. The procedure involved aortobifemoral bypass with suture of the bladder defect and branches of the internal iliac artery by the endoaneurysmal route. Postoperative recovery was uneventful. Upon reexamination 1 month after discharge from the hospital, the patient was asymptomatic. This rare case confirms the gravity of internal iliac artery aneurysm and the importance of therapeutic management to prevent rupture.     

Surgical access of the gluteal artery to embolize a previously excluded, expanding internal iliac artery aneurysm

We describe open exposure of the inferior gluteal artery to allow coil embolization on an enlarging internal iliac artery aneurysm after previous abdominal aortic aneurysm (AAA) repair. An 84-year-old man with a stoma had undergone open AAA repair surgery 8 years previously, during which the proximal aortic neck and both proximal external iliac arteries were ligated, followed by an aorta to right external iliac and left common femoral bypass. Eight years later, he complained of abdominal pain, and a computed tomographic (CT) scan revealed persistent flow in the right internal iliac artery with enlargement to 8 cm in diameter. Because prograde access to the internal iliac artery was not possible as a result of the previous exclusion, the inferior gluteal artery was exposed surgically. Coil embolization of the arteries supplying the internal iliac artery aneurysm was successfully performed. The AAA and internal iliac artery aneurysm were treated by the exclusion technique. Eight years after the operation, CT revealed that the iliac artery had expanded to approximately 8 cm in diameter. The patient was placed face down, and a catheter was directly inserted into the internal iliac artery from the inferior gluteal artery. Four embolization coils were placed in the internal iliac artery and its branches. Absence of blood flow and shrinkage of the aneurysm were subsequently confirmed in the aneurysm, as shown by echogram color duplex scanning and CT scanning at 1 year. This technique could also be applicable for persistent blood flow in an internal iliac aneurysm after endovascular AAA repair, and the size of the aneurysm was reduced to approximately 1 cm 1 year after the operation.     

Diagnostik und Behandlung einer ureteroarteriellen Fistel

Ureteroarterial fistulae are rare after vascular surgery with only 16 cases being reported in the literature. We report a 65-year-old woman who presented with massive gross hematuria following endostenting of an iliac aneurysm. Cystoscopy demonstrated ejaculation of blood from the left orifice and angiography revealed an ureteroiliac fistula between the left ureter and the common iliac artery. Following placement of a vascular endoprosthesis and a double J stent gross hematuria developed. This case highlights the diagnosis and therapeutic approach in patients with suspected ureteroarterial fistula.     

A case of primary signet ring cell carcinoma in urinary bladder]

A case of primary signet ring cell carcinoma in the urinary bladder in a 50-year-old male is described. The patient with a complaint of urinary incontinence was admitted for invasive bladder carcinoma based on cystoscopic examination. The pathological specimen using transurethral resection-biopsy revealed signet ring cell carcinoma. In the preoperative work up, no obvious metastases were found. Following hospitalization, the patient's course gradually worsened with weight-loss, abdominal fullness and dysuria. The operation for total cystectomy was started, but was interrupted when the peritoneal cavity was found to be fully occupied with massive ascites, invasive lesions into nets and surrounding tissue. He died on November 19, 1986, approximately 7 months after onset of symptoms. An autopsy proved that the tumor which was pathologically identified as signet ring cell carcinoma, originated from the urinary bladder invading the perivesical tissues, and also into the intraabdominal space. We found 34 cases in the literature, originating from the urinary bladder. This case is considered to be the 35th. In conclusion, rapid total cystectomy following an early and definite diagnosis is the only procedure to treat such tumors.     

Rupture of internal iliac artery aneurysm presenting as rectus sheath hematoma: case report

This report describes a ruptured internal iliac artery aneurysm that presented as a rectus sheath hematoma (RSH). The patient developed abdominal pain and a large, tense lower abdominal wall mass without peritoneal signs. Computed tomography scan demonstrated a massive RSH contiguous with a ruptured left internal iliac artery aneurysm. Hypovolemic shock prompted immediate laparotomy, aneurysmorrhaphy of the ruptured aneurysm, and evacuation of the rectus hematoma. This uncommon presentation of internal iliac aneurysm rupture should caution against a simple diagnosis of "spontaneous" RSH in a patient with a potentially ruptured iliac aneurysm.     

Acute urinary retention in a 7-year-old girl: an unusual complication of cytomegalovirus cystitis

Acute urinary retention in children is rare. There are a variety of causes about the disease. We report a case of a 7-year-old girl with acute urinary retention and hematuria. Pelvic sonogram revealed an isoechoic mass in the urinary bladder that appeared as a lobulated filling defect over the bladder neck on intravenous urography and computed tomography studies. The surgical specimen from cystoscopic examination showed reactive changes on pathologic analysis. Cytomegalovirus was isolated from urine culture. The girl recovered after supportive treatment.     

Internal carotid aneurysmal formation following spontaneous regression of the dural arteriovenous malformation in the posterior fossa--a case report

The patient was first admitted on August 19, 1975 with 5 years' headache and tinnitus. Physical examination revealed bruit over the left mastoid area. Left angiography, performed in August, 1975, revealed a dural arteriovenous malformation, which was supplied by enlarged left middle meningeal artery, occipital artery, meningohypophyseal artery and superior cerebellar artery and was draining into the left sigmoid sinus. At the first operation, the left external carotid artery was ligated at the neck, and then coagulation of dural vessels was performed through left temporo-occipital craniotomy. Tinnitus and bruit were disappeared after operation. Postoperative right angiogram showed no residual dural AVM, however, ligation of the right external carotid artery was required to reduce symptomes. In June, 1979 the left brachial arteriography was performed, and revealed a dural AVM around the left sigmoid sinus supplied by anastomotic vessels between external carotid artery and cervical artery arising from the vertebral artery. Because of subarachnoid hemorrhage, repeated angiography in April, 1982, revealed progressively enlarging dural AVM, although no aneurysm was seen in the left internal carotid arterial system. The patient readmitted on October, 28, 1983 with severe headache and confusion. CT scan showed slightly high density in the left basal cistern. Angiogram showed no dural AVM and a saccular aneurysm arising from the left internal carotid artery at C2 portion, which was successfully clipped by surgery. Only two cases of spontaneous regression of dural AVM in the posterior fossa were reported previously, and the authors added a case, which showed a newly developed aneurysm after spontaneous regression of the posterior fossa dural AVM.     

Suprarenal mycotic aortic aneurysm: surgical management and follow-up

A case is reported of a rare 7 cm saccular mycotic aneurysm that developed in the suprarenal abdominal aorta of a severely atherosclerotic 63-year-old man from presumed hematogenous inoculation of an atherosclerotic plaque. At operation a right axillobifemoral artery bypass graft was performed along with autotransplantation of the left kidney to the left common iliac vessels and the suprarenal aorta was ligated, excised, and widely debrided. The patient recovered and was in good health for 6 months when sudden occlusion of his axillofemoral graft required thrombectomy for limb salvage and to preserve renal function. Elective thoracoaortic to bilateral iliac artery bypass was successfully undertaken 8 months after the initial operation. However, the patient suffered a fatal myocardial infarction 2 weeks after operation. At autopsy a well-perfused nephrosclerotic kidney, healed aortic ligation, and no graft infections were found.     

Endovascular repair of a ruptured internal iliac arterial aneurysm with a novel application of the aorto-uni-iliac converter device

Internal iliac artery aneurysms are rarely discovered by examination and may consequently present with rupture in a patient without an established diagnosis. Ruptured internal iliac aneurysms harbor a high risk of morbidity and mortality. Although open repair is possible, endovascular repair may be an option in some patients. We present a case of a ruptured internal iliac artery aneurysm with an adjoining ipsilateral common iliac artery aneurysm repaired with a novel use of an aorto-uni-iliac device.     

Spontaneous Rupture of Hypogastric Artery Aneurysm into the Bladder: A Case Report and Review of the Literature

Isolated internal iliac artery (hypogastric) aneurysms are rare. The incidence is less than 0.9%. They are usually asymptomatic. Symptoms can be due to compression of adjacent pelvic structures such as the bladder, ureters, and colon. Rupture of hypogastric artery aneurysms into the bladder has rarely been reported and, when present, is associated with prior abdominal instrumentation or trauma. There is one case where an arteriovesicular fistula formed spontaneously without any instrumentation or trauma, similar to our case. We describe an unusual case of an 81-year-old male with spontaneous rupture of a hypogastric artery aneurysm into the urinary bladder presenting as gross hematuria. This case illustrates the importance of a high index of suspicion in diagnosis and early treatment to reduce morbidity and mortality.     

Major complex pelvic arteriovenous malformation in a patient with Down syndrome

Pelvic arteriovenous malformations (AVM) are rare, and the treatment of this condition presents an interesting challenge. We report the first case of a major AVM in a patient with Down syndrome which was revealed by a massive hematuria. Arteriography showed a bilateral complex iliac artery malformation. The first proximal embolization (unilateral) did not prevent bladder hemorrhage, and the second distal (bilateral) immobilization produced bladder necrosis. However, the patient died despite an emergency cystectomy.     

A rare cause of massive rectal bleeding: internal iliac artery aneurysm

Internal iliac artery aneurysm is a rare cause of lower gastro-intestinal tract (GIT) haemorrhage. A fifty-four year old male patient presented with massive rectal bleeding. Sigmoidoscopy was not conclusive and pelvic angiography revealed an aneurysm from a branch off the main trunk of the anterior division of the right internal iliac artery that was located in juxtaposition to the sigmoid colon. The aneurysm was successfully obliterated by transcatheter arterial embolotherapy with acrylic glue. A high index of suspicion of internal iliac artery aneurysm as a possible cause of lower GIT haemorrhage is of paramount importance. Pelvic angiography is essential for the diagnosis, and embolotherapy with acrylic glue was an effective treatment method in this patient.     

Atherosclerotic aneurysm of the iliac arteries]

Operations were performed on 5 patients with isolated atherosclerotic aneurysms of the iliac arteries, who accounted for 10.9% of patients with aneurysms of vessels treated at the Vascular Department of the Novgorod Regional Hospital from 1983 to 1990. In 4 patients the aneurysm of the iliac artery was an operative finding, in one patient it was found only on postmortem examination. The diagnostic errors and causes of a fatal outcome in 2 patients are discussed. The authors claim resection of the aneurysm with reconstruction of the aorto-ilio-femoral segment to be the operation of choice in aneurysm of the iliac artery.     

A case of sudden gross hematuria caused by an iliac artery-ureteral fistula

A 51-year-old male patient, who had been treated for nonspecific angitis with pulselessness in the upper extremities, was found to have stenosis of the left common iliac artery. Patch grafting was performed for the stenotic lesion of the artery. Sixteen months after the operation, the patient developed a sudden massive hematuria for which he was immediately admitted. He required blood transfusions and bed rest. Pyelography and arteriography revealed almost complete impairment of the left kidney function. During subsequent left retrograde ureterography , the patient again developed massive hematuria and fell in shock. The ureterogram revealed left hydronephrosis and the adhesive left ureter to the site of the patch graft. Extraluminal outflow of contrast medium into the artery was also noted. These findings were considered to indicate the hematuria being an extravasation of blood from an arterio-ureteral fistula formed in the patch graft region. An emergency operation was performed. Contamination was avoided by construction of the femoro-femoral arterial bypass graft to the left lower extremity, prior to the radical removal of the potentially infected fistula and left kidney. The surgical procedures have saved the patient and his lower extremities.     

Bilateral uretero-common iliac arterial fistula with long term uretelal stent: a case report

A 37-year-old man underwent Miles' operation and adjuvant irradiation therapy for rectum cancer in 1999. The patient suffered from bilateral ureteral stricture after the previous therapies. Bilateral double-J ureteral stents were inserted and exchanged at regular intervals. Four years after the start of ureteral stenting, he complicated with gross hematuria and dysuria. When the right double-J stent was exchanged, massive bleeding from external opening of urethra was observed. Retrograde pyelography showed right uretero-iliac arterial fistula. Since endovascular treatment with covered stents had failed, we performed right common iliac artery embolization and femoral-femoral artery bypass. Two days after the operation, gross hematuria developed again. When the left ureteral stent was exchanged, active bleeding from the external meatus of urethra was revealed. Angiography showed extravasation from left common iliac artery. We diagnosed left uretero-iliac arterial fistula. Although we tried endovascular treatment with covered stent that was made of artificial vessel graft and metallic stent, thromboembolism was occurred in the covered stent. Finally, right axillo-femoral artery bypass was indicated. The last treatment achieved long-term good control of uretero-arterial fistula. The present case shows that uretero-arterial fistula is a serious complication of long-term ureteral stenting, especially in the case of post pelvic surgery and irradiation.     

Two ectopic openings of an unduplicated ureter into the bladder neck and the vagina: a case report

A case of two ectopic ureteral openings into the bladder neck and the vagina is reported. A 6-year-old-girl was admitted with gross hematuria and incontinence. The left kidney could not be visualized by excretory pyelography. Voiding cystogram revealed left vesicoureteral reflux. Left ureteral orifice could not be confirmed by cystoscopic examination. In January 1982, left nephroureterectomy was carried out. Contrast material injected into the left ureter during the operation was found to be drained into the bladder and the vagina. Thus, left ureter was resected close to the end of the ureter to avoid injury of the urethra and its sphincter. After the operation, incontinence disappeared. This case is the second case of two ectopic openings of unduplicated ureter.     

超选择性双侧髂内动脉分支栓塞术治疗膀胱出血性疾病(附18例报告)

目的 评价超选择性双侧髂内动脉分支栓塞术治疗晚期膀胱肿瘤所致大出血及出血性放射性膀胱炎的治疗效果。方法应用大小不等的明胶海绵颗粒和带纤毛钢圈，对14例晚期膀胱肿瘤及4例放射性膀胱炎所造成顽固性出血患者进行了超选择性双侧骼内动脉分支栓塞术.结果 采后1-24h尿液转清，3d内血尿基本消失，随访3-36个月，无严重血尿复发。结论超选择性双侧髂内动脉分支栓塞术是一种治疗晚期膀胱肿瘤及出血性放射性膀胱炎所致顽固性出血有效的治疗方法。     

Endovascular stent graft for management of ureteroarterial fistula: a case report

We report a case of ureteral-iliac artery fistula and its minimally invasive management with endovascular stent grafting. A 76-year-old male was admitted with massive gross hematuria from an ilial conduit. He underwent a radical cystectomy with ileal loop urinary diversion for bladder cancer 7 months ago and had undergone placement of a 7 Fr single-J ureteral catheter for repair of a partial disruption of the left ureteroileal anastomosis. Although the fistula was not confirmed radiographically, a left ureteral-common iliac artery fistula was highly suspected. The patient was treated by percutaneous placement of an autoexpandable covered stent graft across the left common iliac and left external iliac artery. After successful endovascular management of the ureteroarterial fistula, the patient's hematuria resolved and he recovered fully. During 10 months of follow up, he has been free of hemorrhagic episodes. Because open surgical repair may be difficult and associated with significant risk for complications, endovascular intervention may provide a safety treatment alternative.     

门脉高压致膀胱静脉曲张一例报告并文献分析

目的 提高对门静脉高压所致膀胱静脉曲张临床诊治特点的认识. 方法 患者男,63岁.间断无痛性全程肉眼血尿7个月入院.既往肝硬化病史9年.查体未见阳性体征.实验室检查血小板56×109/L.超声检查示脾大(5.8 cm×14.0 cm);膀胱左侧壁和前壁可见一内部充满静脉血流信号的网状结构(7.0 cm× 2.4 cm),向膀胱左侧外上方延伸,与一粗大静脉血管相连.膀胱镜下可见左侧壁和前壁的曲张静脉血管(3.0 cm×5.0 cm).CT血管重建检查示膀胱曲张血管与肠系膜下静脉相连,最终汇入脾静脉.患者临床诊断为肝硬化、门静脉高压、膀胱静脉曲张.行膀胱周围血管离断术治疗. 结果 患者手术过程顺利,术后血尿症状消失,1个月后复查超声膀胱结构正常. 结论 肝硬化门静脉高压患者可发生膀胱静脉曲张,膀胱周围血管离断手术治疗效果满意.