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Year : 2006  |  Volume : 16  |  Issue : 4  |  Page : 559-562
Spontaneous resolving of the aneurysm of ileocolic artery, branch of superior mesenteric artery ----Imaging findings


Department of Radiology and Gastro surgery G.B.Pant hospital and Maulana Azad Medical College, New Delhi-2, India

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Date of Submission22-Feb-2006
Date of Acceptance10-Oct-2006
 

   Abstract 

A rare case of ileo-colic aneurysm- branch of superior mesenteric artery is presented. Injuries to branches of superior mesenteric artery are unusual and often difficult to diagnose, yet require prompt recognition and treatment to prevent exsanguinating hemorrhage or bowel ischemia(1).The present patient was a known case of RHD with severe AS and moderate AR and was operated in 2001.Patient has a history of trauma in right iliac fossa and was diagnosed as aneurysm on color Doppler, confirmed on CT angio, MR angiography and conventional; angiography. Since Patient was asymptomatic when came to radiology deptt, intervention was deferred for a week. After a week when color Doppler was performed it showed on resolved hematoma and no aneurysm. This is a unique case of ileocolic aneurysm resolving on its own .only few cases of ileocolic artery aneurysm have been reported in literature; either they are treated with laprotomy or by interventional procedure.

Keywords: ileocolic artery aneurysm, Colour Doppler, CT, CT angio, MR Angio

How to cite this article:
Sharma A K, Mishra P K, Chibber S, Aditya. Spontaneous resolving of the aneurysm of ileocolic artery, branch of superior mesenteric artery ----Imaging findings. Indian J Radiol Imaging 2006;16:559-62

How to cite this URL:
Sharma A K, Mishra P K, Chibber S, Aditya. Spontaneous resolving of the aneurysm of ileocolic artery, branch of superior mesenteric artery ----Imaging findings. Indian J Radiol Imaging [serial online] 2006 [cited 2019 Aug 22];16:559-62. Available from: http://www.ijri.org/text.asp?2006/16/4/559/32268

   Introduction Top


We present an aneurysm of ileocolic artery after a minor trauma in the patient who had been already treated for MS, AS and AR in 2001.Superior mesenteric branch aneurysms are rare and usually become symptomatic at the time of rupture.Pain; GI blood loss and Intraabdominal hemorrhage draw attention to the presence of aneurysms in 70 % of the reported cases


   Case Report Top


A 38-year-old male patient came to hospital with a pain in right para umbilical region and right iliac fossa.Patient is a known case of RHD with severe AS with moderate AR since 24th October and is on warfarmin, persantin and lactose.Patient had normal values of Hb(11),raised ESR(95),serum creatinine(0.6),OT/PT(39/43),serum bilirubin(1mgm%).On physical examination there was a vague mass in the right lumbar region.Clinical diagnosis of appendicular abscess was thought of. Patient was sent to Radiology deptt and US showed an evidence of hypo echoic lesion in the right lumbar region. On color Doppler, there was evidence aneurysm and Doppler spectrum was characteristic of pulsatile aneurysm [Figure - 1],[Figure - 2].The origin of aneurysm was not clear. Patient was taken for CT and CT angiography ,which showed an evidence of aneurysm originating from ileo-colic branch of superior mesenteric artery [Figure - 3],[Figure - 4],[Figure - 5],[Figure - 6].This was also confirmed on MR and 3D contrast enhanced angiography [Figure - 7],[Figure - 8],[Figure - 9] and DSA.Patient was fixed for coiling of the aneurysm after 3 days as patient was asymatomatic.Before taking him to cath lab,colour Doppler was performed it was found that there is only hypo echoic area and there was no aneurysm flow as well as no spectral pattern suggestive of aneurysm [Figure - 10],[Figure - 11].Patient has been kept under observation.


   Discussion Top


Superior mesenteric artery aneurysm is rare, being observed in one in every 12,000 autopies.Only 5.5 to 85 of visceral aneurysms and less than 0.55 of intraabdominal aneurysms are SMA aneurysm[4]

Superior mesenteric branch aneurysms all the more very rare and usually become symptomatic at the time of rupture.Pain, gastrointestinal blood loss and intraabdominal hemorrhage draw attention to the presence of aneurysms in70% of the reported cases[1],[2].In the presented case patient did not severe symptoms and had come to us in the latter stage. Patient had a previous history of cardiac surgery and also has given the history of mild trauma in the right iliac fossa.We have documented the aneurysm on all modalities. Though CDU provides an accurate diagnosis of SMAA but it becomes difficult when one of its branches is involved [5].Noah Appel etal (2003) has reported a case report in which percutaneously stent graft treatment is advocated in SMA and internal iliac artery aneurysm. John H etal 1999 repaired traumatic ileo-colic pseudo aneurysm by Tran catheter treatment. We have reported this case because of its very rare nature and resolving own its on .Patient has been followed up regularly and did not have any symptom.[6]

 
   References Top

1.Chou TF,Chang CD,Chang H,Chang KJ,Hung CR.Aneurysm arising from the branch of the superior mesenteric artery Formos Med Assoc. 1991 Sep;90(9):853-6.  Back to cited text no. 1    
2.John H.Rundback, MD, Saleem Chughtai, MD Traumatic ileocolic pseudoaneurysm: Diagnosis and Tran catheter treatment. Catherization and Cardiovascular interventions, vol 48, issue 2, pages 217-219,1999.  Back to cited text no. 2    
3.Cely, Cynthia M.D.; Stollman, Neil H. M.D. Lupus Abdominal Crisis owing to rupture Of an ileocolic aneurysm with successful angiographic treatment. Journal of Clinical Gastroenterology.32 (4):347-350.april 2001.  Back to cited text no. 3    
4.Ferrara BE. Mesenteric artery aneurysm. South Med J 1986;79:366-7.  Back to cited text no. 4  [PUBMED]  
5.Bates K,Sorrell K,Carpenter J Superior mesenteric artery aneurysm identified by color duplex ultrasonography: Two case reports Journal of vascular technology, 25,4,2001,226-230.  Back to cited text no. 5    
6.Noah Appel etal. Percutaneous stent-graft treatment of superior mesenteric and internal iliac artery psueudoaneurysms.Journal of vascular and interventional Radiology 14:917-922(2003)  Back to cited text no. 6    

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Correspondence Address:
A K Sharma
C10 Kendriya Vihar Sector 51 Noida
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.32268

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    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8], [Figure - 9], [Figure - 10], [Figure - 11]



 

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    Abstract
    Introduction
    Case Report
    Discussion
    References
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