Rare Presentation of Isolated Pseudoaneurysms of the External Iliac Artery with Acute Appendicitis in a Type 1 Diabetic Patient - A Case Report

Abstract

A 16-year-old female presented with pain in the right iliac fossa (RIF) and fever in diabetic ketoacidosis (DKA) with no significant findings consistent with a differential of co-existing aneurysms. Ultrasound of her abdomen was suggestive of likely sealed off perforation of the appendix with collection in the RIF. After resolution of her DKA, she underwent appendicectomy laparoscopically which was converted to open in view of dense adhesions. She developed per rectal bleeding post appendicectomy evaluation of which with computed tomography (CT) angiography was suggestive of two isolated right external iliac artery (EIA) aneurysms which were then treated with covered metallic stents. While isolated aneurysm of the external iliac artery itself are extremely rare, the association of appendicitis with pseudoaneurysm of the EIA reinstates one of the mechanisms of formation of such aneurysms via direct extension of infection. Herein, we discuss the successful management of ruptured pseudoaneurysms of the right EIA in an operated case of acute appendicitis with type 1 diabetes mellitus. First described by William Osler in 1885, mycotic pseudoaneurysm were termed “mycotic” for he found that in patients of infective endocarditis, the aortic arch aneurysms resembled fleshy fungal vegetations.1 Pseudoaneurysm as a complication of appendicitis, is an extremely rare condition and delay in diagnosis results in sepsis, arterial rupture and death.2-8 We present a similar case of right EIA pseudoaneurysm associated with acute appendicitis in a type 1 diabetic young female treated successfully with an endovascular covered stent.