Rupture of internal iliac artery aneurysm into the bladder following aortic aneurysm repair

This report describes a case of ruptured internal iliac artery aneurysm int o the bladder after repair of an infrarenal abdominal aortic aneurysm. Aort ic repair consisted of resection of the aneurysm followed by prosthetic int erposition to reestablish arterial continuity. During the postoperative per iod, the patient had ischemia of left colon, which was successfully treated by the Hartmann procedure. A right internal iliac artery aneurysm measurin g 50 mm in diameter was demonstrated by an abdominal CT scan during the ini tial hospitalization but was considered stable, since ultrasonography showe d no change in diameter at 3 months and 1 year. The patient was lost from f ollow-up until 3 years later when he was hospitalized after rupture of the right iliac artery aneurysm, then measuring 120 mm in diameter, into the bl adder. Surgical repair was undertaken. The procedure involved aortobifemora l bypass with suture of the bladder defect and branches of the internal ili ac artery by the endoaneurysmal route. Postoperative recovery was uneventfu l. Upon reexamination 1 month after discharge from the hospital, the patien t was asymptomatic. This rare case confirms the gravity of internal iliac a rtery aneurysm and the importance of therapeutic management to prevent rupt ure.