Life-threatening intra-abdominal hemorrhage from left superior colonic artery pseudoaneurysm after percutaneous renal biopsy: successful treatment with superselective arterial embolization

Development of ileocolic artery pseudoaneurysm after renal biopsy

“…Shortly after the biopsy, she presented with abdominal pain and anemia. Angiography revealed active bleeding in the ruptured left superior colonic artery pseudoaneurysm [7] . In 2015, Madhusudhan [2] reported a case of a 60-year-old woman who developed a left colic artery pseudoaneurysm.…”

“…Vascular injuries are typically renal pseudoaneurysms or arteriovenous fistulas (AVFs), and pseudoaneurysms of extrarenal arteries are extremely rare [2] . A few cases have been reported: abdominal aorta, lumbar artery, jejunal artery, and left colic artery [2 – 7] . To the best of our knowledge, cases of ileocolic artery pseudoaneurysms and multiple injuries to extrarenal arteries, related to renal biopsy have never been reported.…”

Endovascular embolization of pseudoaneurysm of left colic artery developing after renal biopsy

“…[ 2 6 ] Involvement of left colic artery has been reported only once in English literature. [ 6 ] The left colic artery arises from the inferior mesenteric artery and divides into ascending and descending branches and the former courses anterior to the left kidney toward the descending colon and anastomoses with the branches of middle colic artery and first sigmoid artery to form the vascular arcade. [ 9 ] Due to its location close to left kidney, it may rarely be at risk of injury during biopsy, especially when biopsy is done without guidance.…”

“…The patients of extra-renal arterial involvement develop retroperitoneal hematoma or hemoperitoneum rather than hematuria and may present with hypotension, pain/swelling and/or drop in hemoglobin. [ 2 3 4 5 6 ] Although ultrasonography with color Doppler may be useful in some cases, most of the patients with persistent symptoms beyond 24–48 h need CT angiography for evaluation of renal and extra-renal arteries. Adequate precautions are needed while performing CT scan as iodinated contrast may further deteriorate the already compromised renal function.…”

“…[ 2 3 4 5 ] But injury to left colic artery is very rare with only one case reported in literature. [ 6 ] We report a case of left colic artery PsA developing after renal biopsy, which was successfully embolized using microcoils.…”