Cecal Perforation Leading to Lumbar Artery Mycotic Pseudoaneurysm

Purpose: Mycotic pseudoaneurysm (PSA; infected PSA) is an infectious arteritis, leading to the destruction of the arterial wall. To our knowledge, no case of lumbar artery mycotic PSA after bowel perforation has ever been reported in the literature. Only two cases of internal iliac artery mycotic PSA after bowel perforation have been reported in the literature. We report a case of lumbar and internal iliac arteries PSAs after cecal perforation complicating a neglected cecal volvulus.

Materials and Methods: A 46-year-old woman with a previous history of pulmonary embolism (taking enoxaparin) and cecal perforation 5 months before this admission presented to the emergency department with shortness of breath, altered mental status, and right lower quadrant abdominal pain of 2 days’ duration. She was hypotensive, with abdominal skin bruises and abdominal distension. Laboratory studies revealed azotemia, lactic acidosis, severe anemia, and coagulopathy.

Results: Computed tomography of the abdomen and pelvis with contrast showed massive retroperitoneal hemorrhage. Abdominopelvic angiography revealed bleeding PSAs of the right and left internal iliac arteries and the right fourth lumbar artery. Gelfoam embolization was successfully performed with cessation of bleeding. The patient’s was admitted 5 months earlier with bowel obstruction secondary to cecal volvulus, complicated by cecal perforation. Laparotomy revealed copious amount of pus in the abdominopelvic area, and abdominal wash of the purulent fluid, diverting ileostomy, and cecal repair were done.

Conclusions: Neglected cecal perforation with free pus in the abdominopelvic cavity can rarely lead to vascular wall infection of the nearby arteries, producing PSAs, which can be complicated by massive hemorrhage. In this case, in addition to the iliac arteries, the lumbar artery was also involved, which was not described before in the literature in the setting of bowel perforation.