Rupture of internal iliac artery aneurysm presenting as rectus sheath hematoma

Case report

de Donato, Gianmarco MD
Neri, Eugenio MD
Baldi, Irene MD
Setacci, Carlo MD

University of Siena, Siena, Italy

Reprint requests: Gianmarco de Donato, MD, Chirugia Vascolare, Universita di Siena, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy (e-mail: [email protected]).

Competition of interest: none.

Submitted Mar 25, 2003; accepted Jul 31, 2003.

Journal of Vascular Surgery 39(1):p 250-253, January 2004.

This report describes a ruptured internal iliac artery aneurysm that presented as a rectus sheath hematoma (RSH). The patient developed abdominal pain and a large, tense lower abdominal wall mass without peritoneal signs. Computed tomography scan demonstrated a massive RSH contiguous with a ruptured left internal iliac artery aneurysm. Hypovolemic shock prompted immediate laparotomy, aneurysmorrhaphy of the ruptured aneurysm, and evacuation of the rectus hematoma. This uncommon presentation of internal iliac aneurysm rupture should caution against a simple diagnosis of “;spontaneous” RSH in a patient with a potentially ruptured iliac aneurysm.