Ureteral obstruction secondary to iliac artery aneurysm

A 65-year-old woman was seen in September, 1986, because of general malaise and dull pain in the left flank. Physical examination was unremarkable. Murmur was not heard over the abdomen. An excretory urogram showed left hydronephrosis and a retrograde pyelogram showed extrinsic obstruction at the level of the transverse process of the 5th lumbar spine. Computed tomography (CT) showed a mass with irregular calcification in its center. The mass was assumed to be located in the left iliac artery and as it was enhanced homogeneously, iliac aneurysm was suspected. Angiography revealed an aneurysm of the left iliac artery involving common, external and internal iliac arteries. The patient was treated by ligation of aneurysm, aorto-femoral graft bypass and ureterolysis. Histopathological findings showed aneurysm due to atherosclerosis. A postoperative excretory urogram showed improvement of hydronephrosis. Ureteral obstruction due to iliac aneurysm is unusual but it should be considered when performing differential diagnosis of extrinsic ureteral obstruction. CT is a useful diagnostic tool and aortography should be done to make a final diagnosis. Treatment is based on resection or ligation of aneurysm with ureterolysis.     

Ureteral obstruction secondary to retained ovarian remnants: a case report and review of the literature

A case is reported of ureteral obstruction from retained retroperitoneal corpus luteum. Previously, the patient had undergone a hysterectomy and salpingo-oophorectomy with incomplete removal of ovarian tissue on the affected side. The ureteral obstruction was treated by excision of the mass and ureterolysis.     

Ureteral obstruction secondary to iliac artery aneurysm.

A patient with an unusual unilateral ureteral obstruction secondary to mechanical obstruction by a common iliac artery aneurysm in association with an abdominal-aortic aneurysm is presented. A diagnosis of ureteral obstruction should be suspected in a patient with flank or abdominal pain and an infra-umbilical (iliac) aneurysm. Treatment is directed toward the aneurysm. The aneurysmal wall attachments to the ureter should be left undisturbed.     

Ureteral endometriosis: a case report and a review of the Japanese literature

A 42-year-old woman was referred to our hospital because of abdominal fullness and a large abdominal mass. Computed tomography (CT) demonstrated bilateral ovarian tumors, uterine myoma and left hydronephrosis. On excretory urography the left kidney was not visualized and retrograde pyelography (RP) revealed left hydronephrosis and a filling defect in the left lower ureter. Based on the diagnoses of endometriosis of bilateral ovaries, uterine myoma and a left ureteral tumor, abdominal total hysterectomy, right salpingo-oophorectomy and partial ureterectomy were performed. Pathologically, in the uterus, both leiomyoma and adenomyosis, and endometriosis of the right ovary and ureter were diagnosed. Medication with buserelin acetate was started.     

Ureteral stenosis due to endometriosis: a case report

A 37-year-old woman was admitted to our hospital to examine left hydronephrosis. Retrograde pyelography showed left lower ureteral stricture. Abdominal CT scan revealed a tumor 1 cm in diameter in the left lower ureteral stricture. The diagnosis of left hydronephrosis and hydroureter due to left lower ureteral stricture was made, and left uretero-ureterostomy was performed. The histological findings revealed extrinsic type ureteral endometriosis. The present case, and the cases reported in the Japanese publications are reviewed.     

Spontaneous dissection and rupture of common iliac artery in a patient with fibromuscular dysplasia: a case report and review of the literature on iliac artery dissections secondary to fibromuscular dysplasia

Spontaneous dissection and rupture of the iliac artery is an unusual finding in patients with fibromuscular dysplasia (FMD). We report the case of a patient with FMD who required emergent surgery because of rupture of an iliac artery dissection, and review 9 previously reported cases of iliac artery dissection associated with FMD. A 30-year-old man had abdominal pain, and went into shock. Angiograms revealed dissection of the left common iliac artery with extravasation. At emergent surgery the rupture site was in the proximal left common iliac artery and extended to the left external iliac artery. Interposition of the diseased artery with a Dacron graft was attempted, but cardiac arrest occurred, and resuscitation was unsuccessful. Pathologic examination showed typical characteristics of diffuse medial FMD. Ten cases (5 male and 5 female patients), including the present case, with dissection of iliac arteries associated with FMD have been reported. Median patient age was 45 years (range, 29-56 years). Three of the 10 patients had acute onset of symptoms, and the remainder had gradual development of intermittent claudication or groin pain. Only the present case had evidence of rupture. The site of dissection was in the external iliac artery in 8 patients and the common iliac artery in 2 patients. Anatomic bypass or interposition of the diseased artery was performed in 8 patients; the others received conservative treatment. There was no mortality in the 9 previously reported cases. Fatal acute dissection and rupture of the common iliac artery occurred in a patient with FMD, even though the clinical course of this disease is relatively benign. FMD should be considered the cause of dissection and rupture of the iliac artery in a patient with symptoms but of non-atherosclerotic age.     

Ureteral obstruction owing to over pressure of a normal right common iliac artery: a case report

We report a case in which a normal right common iliac artery in a normal anatomical relationship to the right ureter at the crossing point caused partial urinary tract obstruction apparently by an over pressure effect. The ureter was attached to the promontorium periosteum following ureterolysis to relieve the obstruction. To our knowledge, such a condition has not been reported previously. We believe that over pressure of the common iliac artery should be considered in the differential diagnosis of extrinsic ureteral obstruction, particularly in muscular subjects.     

Ureteral obstruction due to retroperitoneal fibrosis secondary to a solitary internal iliac aneurysm

We report a case of ureteral obstruction due to retroperitoneal fibrosis secondary to a solitary left internal iliac aneurysm. It has been reported that as a cause of ureteral obstruction, an internal iliac aneurysm without aortic and/or common iliac aneurysms is very rare. In the present case, magnetic resonance imaging was a useful modality to diagnose retroperitoneal fibrosis secondary to an internal iliac aneurysm as a direct cause of ureteral obstruction.     

盆腔侵袭性纤维瘤致输尿管狭窄1例报告并文献复习

目的 探讨盆腔侵袭性纤维瘤（AF）的临床特征及诊治方法.方法 报告1例盆腔AF致单侧输尿管狭窄患者的临床资料.结果 手术切除肿块、输尿管下段、部分腹膜及左侧精囊.病理诊断：（盆腔）侵袭性纤维瘤.术后予以放疗,随访3月未见复发.结论 盆腔AF临床罕见,侵犯泌尿系统时易被误诊为泌尿系肿瘤.结合临床表现及影像学特点应考虑到盆腔AF的可能,最终诊断依据病理.治疗采取以手术为主的个体化综合治疗.     

Ureteral stent-related aortoureteric fistula: case report and literature review

We describe a case of early postoperative aortoureteric fistula following exenterative surgery treated with wet ostomy with bilateral ureterosigmoidostomies and ureteric stent placement. A high index of clinical suspicion is required, as diagnosis is often difficult.     

False aneurysm of the common femoral artery secondary to migration of a threaded acetabular component. A case report and review of the literature

A 66-year-old woman with severe rheumatoid arthritis had revision of a protrusio acetabuli component with a threaded socket. Subsequent anteromedial migration of the socket and thread laceration of the common femoral artery resulted in a pseudoaneurysm and massive pelvic erosion seven months later. Vascular reconstruction and excisional arthroplasty were necessary. Later, gracilis and gluteal muscle flaps were swung to fill the resultant pelvic cavity. The hip was nonreconstructable. Ten months later the wound healed and the patient was ambulating in a walker. This represents a previously unreported cause of vascular injury complicating total hip arthroplasty (THA). A comprehensive review of the English and European literature illustrates the various mechanisms of vascular trauma in this setting and provides a rational basis for prevention.     

Femoral vein aneurysm: a case report and review of the literature

Primary venous aneurysms are rarely encountered lesions. Case reports have been described throughout the venous system. The lesions are usually symptom-free being found as a subcutaneous mass, an incidental finding on an imaging study, or during the work-up for deep venous thrombosis. However, embolism and rupture have been rarely described. A femoral vein aneurysm is reported, along with a current review of the literature of venous aneurysms.     

Ileal artery aneurysm: a case report and review of literature

In a 70-year-old Japanese male who had a history of a radical operation of ruptured descending thoracic aortic aneurysm, the ileal artery aneurysm developed asymptomatically during postoperative follow up period. The aneurysm was about 10 by 4.5 by 4 cm in size and atherosclerosis microscopically. This case seemed to be the 20th case of superior mesenteric artery aneurysm and the 4th case of ileal artery aneurysm reported in Japan. Furthermore, this may be the first report of ileal artery aneurysm associated with thoracic aortic aneurysm in Japanese and English literature.     

Popliteal vein aneurysm: a case report and review of literature

The authors report a case of popliteal vein aneurysm (PVA) in a healthy patient who presented with symptoms and review the literature. A 40-year-old healthy male presented with hypoxia secondary to pulmonary emboli. He underwent diagnostic tests revealing a suprageniculate saccular PVA, which was treated by aneurysmectomy and lateral venorrhaphy. A follow-up duplex scan after 18 months showed patent popliteal vein in an asymptomatic patient. A review of 120 cases identified revealed that the most common presentation of PVA is because of thromboembolic complications, often having saccular morphology. Patients were at risk of thromboembolic complications whether intraluminal thrombi were present (63% of the cases) or not. Patients treated with anticoagulation alone had a failure rate of 43%, with thromboembolic complications. Surgical repair of PVA--regardless of the aneurysm size--should be considered in all patients to decrease the risk of thromboembolization.     

Iliac venous aneurysm: a case report and review of literature

Primary iliac vein aneurisms are extremely rare being described as anomaly, without any history of trauma, cardiovascular pathology or arteriovenous fistula. This clinical condition has a high rate of potentially fatal complications: pulmonary embolism; ruptured aneurism; deep vein thrombosis. There are only 7 cases of iliac vein aneurism described in the literature. We describe an additional case of a 59-year old patient presented with abdominal pain, right lower limb edema and palpable mass in the right iliac area. Ultrasound (US) revealed a liquid formation, confirmed by computed tomography (CT). Surgical removal of the aneurism with lateral venorrhaphy was performed. Postoperative evolution was uneventful. The patient is asymptomatic during 36 month follow-up.