Treatment of ruptured rectal artery aneurysm in a patient with neurofibromatosis

Hidehiko Nemoto; Kensaku Mori; Yohei Takei; Shunsuke Kikuchi; Sodai Hoshiai; Yoshiyuki Yamamoto; Takahito Nakajima

doi:10.1186/s42155-022-00317-y

Treatment of ruptured rectal artery aneurysm in a patient with neurofibromatosis

CVIR Endovasc. 2022 Aug 4;5(1):37. doi: 10.1186/s42155-022-00317-y.

Authors

Hidehiko Nemoto¹, Kensaku Mori², Yohei Takei¹, Shunsuke Kikuchi³, Sodai Hoshiai⁴, Yoshiyuki Yamamoto⁵, Takahito Nakajima⁴

Affiliations

¹ Department of Radiology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, 305-8576, Japan.
² Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Japan. moriken@md.tsukuba.ac.jp.
³ Department of Radiology, Tsuchiura Kyodo General Hospital, 4-1-1 Ohtsuno, Tsuchiura, 300-0028, Japan.
⁴ Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Japan.
⁵ Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Japan.

Abstract

Background: Superior rectal artery (SRA) aneurysms are rare. Although melena is the most common symptom, it has not been observed in cases of aneurysms located in the SRA trunk. Here, we report a case of a ruptured SRA trunk aneurysm successfully treated with coil embolization. Including our case, three of the four reported cases of SRA trunk aneurysms were related to neurofibromatosis type 1 (NF1).

Case presentation: A 52-year-old woman with NF1 was referred to our hospital for the investigation of an abdominal mass with back pain. She had previously undergone a blood transfusion at another hospital for anemia without melena. Computed tomography angiography revealed a ruptured SRA trunk aneurysm measuring 3 cm in diameter and surrounded by a retroperitoneal hematoma. The aneurysm was isolated by embolizing the SRA trunk distally and proximally. Distal embolization was performed retrogradely from the internal iliac artery (IIA) via the middle rectal artery (MRA)-SRA anastomosis because the antegrade approach from the inferior mesenteric artery (IMA) failed. To our knowledge, this is the first case of successful coil embolization of an IMA branch through the IIA.

Conclusion: SRA trunk aneurysms are rare; however, they are frequently associated with NF1. Antegrade distal embolization beyond the aneurysm is sometimes difficult to achieve. In such cases, a retrograde approach via MRA-SRA anastomosis can be the choice for isolating SRA trunk aneurysms.

Keywords: Aneurysm; Coils; Embolization; Neurofibromatosis type 1; Rupture; Superior rectal artery.