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Renal Artery Pseudoaneurysm Rupturing into the Small Intestine Causing Gastrointestinal Bleeding.

Byline: Xiao-Jun. Zhao, Jian-Qiu. Sheng

A 21-year-old man was hospitalized with intermittent melena for 6 months. The patient was placed with a renal artery stent because of a left renal pseudoaneurysm caused by trauma one year ago. Gastroscopy revealed traces of dark red blood in the lower segment of the duodenum, and enteroscopy revealed a large, purplish-red mass at the junction between the duodenum and jejunum [Figure 1]. The surface structure of the mass was unclear, and the mass was soft and appeared pedicled. Biopsy suggested hemorrhagic degeneration associated with inflammatory cell infiltration. Abdominal computed tomography showed a low-density para-aortic mass surrounding the renal artery, as well as an endovascular metal stent attached to the left renal artery and abdominal aorta [Figure 2]. The patient underwent surgical treatment due to continued bleeding from the intestinal mass. During the surgery, the intestinal mass and the abdominal aorta were found to be closely linked. Resection and anastomosis were performed to remove the intestinal tumor and connect the duodenum and the upper jejunum. A postsurgical pathology examination indicated necrotic tissue degeneration and areas with neutrophil infiltration. The intraoperative findings suggested that the left renal artery pseudoaneurysm had ruptured into the small intestine to form an intestinal pseudotumor, which caused the gastrointestinal bleeding.{Figure 1}{Figure 2}

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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Title Annotation:Clinical Picture
Author:Zhao, Xiao-Jun; Sheng, Jian-Qiu
Publication:Chinese Medical Journal
Article Type:Case study
Date:Jul 27, 2017
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