Mohammed Suoub1, Ghassan Talahmeh2, Salah Abdelraouf3, Fadi Sawaqed4. 1. Department of Special Surgery, Faculty of Medicine, Mut'ah University, Karak, 61710, Jordan. dr_suoub@yahoo.com. 2. Gardens Hospital, Amman, Jordan. 3. Jordan Hospital, Amman, Jordan. 4. Department of Special Surgery, Faculty of Medicine, Mut'ah University, Karak, 61710, Jordan.
Abstract
BACKGROUND: Pseudoaneurysm of a vesical artery is an extremely rare iatrogenic complication; however, it may cause fatal haematuria. CASE PRESENTATION: A 21-year-old Arab Jordanian male had multiple optical urethrotomies for an iatrogenic urethral stricture after he had rectal surgery for Hirschsprung's disease at the age of 2 years. During one of his admissions to the Emergency Room (ER) with urinary retention, an attempt at suprapubic catheter insertion was complicated by massive bleeding at the insertion site of the catheter. Abdominal exploration showed a distended urinary bladder with clots and bleeding seen at the bladder neck that was controlled with multiple sutures. The patient rebled again two times; the first was controlled with cystoscopy and cautery for a pulsatile bleeder seen at the bladder neck. The second time, the patient required blood transfusion of three units of packed red blood cells. Angiography was performed, and a pseudoaneurysm at the base of the urinary bladder from the inferior vesical artery was diagnosed, which was controlled by embolization. CONCLUSION: Pulsatile bladder haemorrhage following urological intervention is suggestive of pseudoaneurysm or arteriovesical fistula, and angiography with embolization is recommended.
BACKGROUND:Pseudoaneurysm of a vesical artery is an extremely rare iatrogenic complication; however, it may cause fatal haematuria. CASE PRESENTATION: A 21-year-old Arab Jordanian male had multiple optical urethrotomies for an iatrogenic urethral stricture after he had rectal surgery for Hirschsprung's disease at the age of 2 years. During one of his admissions to the Emergency Room (ER) with urinary retention, an attempt at suprapubic catheter insertion was complicated by massive bleeding at the insertion site of the catheter. Abdominal exploration showed a distended urinary bladder with clots and bleeding seen at the bladder neck that was controlled with multiple sutures. The patient rebled again two times; the first was controlled with cystoscopy and cautery for a pulsatile bleeder seen at the bladder neck. The second time, the patient required blood transfusion of three units of packed red blood cells. Angiography was performed, and a pseudoaneurysm at the base of the urinary bladder from the inferior vesical artery was diagnosed, which was controlled by embolization. CONCLUSION:Pulsatile bladder haemorrhage following urological intervention is suggestive of pseudoaneurysm or arteriovesical fistula, and angiography with embolization is recommended.
Authors: Steven Haegeman; Johan Vaninbroukx; Sam Heye; Steven Joniau; Hendrik Van Poppel; Raymond Oyen; Geert Maleux Journal: Vasc Endovascular Surg Date: 2013-08-22 Impact factor: 1.089