Presentation
Rectal bleeding, drop in hemoglobin. Underwent EVAR 10 years earlier.
Patient Data
Status post aorto-bi-iliac stent graft placement.
Status post total gastrectomy and splenectomy.
Case Discussion
Admitted for workup for rectal bleeding and abdominal pain. CT angiography revealed an endoleak in a huge saccular aneurysm that was shown to be a type IIb endoleak, as several arteries were involved. Strangely enough, the endoleak occurred 10 years after stent-graft placement. The width of the aneurysm at the time of stent graft placement was 6.3 cm, compared to 11.5 cm on the present CT study.
Angiography demonstrated a patent inferior mesenteric artery (IMA) and lumbar artery. The patient underwent laparotomy, whereby a sacotomy was performed and the IMA and lumbar artery were ligated. The patient, a nonagenarian, recovered well from the operation and lived on for over a year.
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