Traumatic visceral artery aneurysm: presentation as massive hemorrhage from perforation into an adjacent hollow viscus.

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Abstract

BACKGROUND

While diagnosis of extremity pseudoaneurysm is usually straightforward, pseudoaneurysms arising from visceral arteries may be occult. Perforation of a visceral artery pseudoaneurysm into an adjacent hollow viscus with subsequent hemorrhage has been rarely reported.

OBJECTIVE AND DESIGN

To retrospectively evaluate the cause, clinical presentation, and outcome of patients with bleeding traumatic visceral artery aneurysms.

MATERIALS AND METHODS

Records of nine patients with visceral hemorrhage due to posttraumatic arterial aneurysms.

RESULTS

All had penetrating torso trauma 2 to 52 (mean, 12.3) weeks before presentation to our facility and had undergone 1 to 5 (mean, 2.2) prior operations. They had 2 to 15 episodes of hemorrhage into the gastrointestinal (seven cases), respiratory (one case), and urinary (one case) tracts. All underwent emergent surgery with ligation of the involved artery and resection of the corresponding portion of viscus. Evidence of prior attempts at hemostasis with multiple heavy ligatures was evident in all cases. All patients recovered without further complications.

CONCLUSIONS

Traumatic visceral artery aneurysms are usually due to penetrating trauma. They present as episodes of massive bleeding through one of the hollow viscera, and may stop bleeding without direct intervention only to occur again. Prompt operative therapy is usually necessary.

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