Introduction :

    Aneurysm is an irreversible dilatation of an artery to at least one and one-half times its normal diameter. It may involve all the layers of the artery wall ( true aneurysm ) or only a portion of the wall and surrounding tissue (false aneurysm). Traumatic aneurysm is an example of false aneurysm which are characterized by focal defect in the arterial wall, with hemorrhage controlled by surrounding tissues. With time, a fibrous capsule forms around the hematoma, but a definite risk of rupture present.

The Case:

    Sixteen years old male brought to A/E after history of stab wounds to the left thigh and buttock at work by a schizophrenic patient. On examination patient was noticed to have 1*1 cm stab wound at left gluteal region on the lateral aspect, another 1*1 cm stab wound at the lateral aspect of the left upper thigh. There was no active bleeding and all the peripheral pulses were intact.
Wounds were sutured and the patient was admitted for IV antibiotics and close observation.
In the hospital, patient developed left gluteal swelling and pain, along with Hb dropping from 9.8 g/dL on admission to 7.0 g/dL after one day.

    Patient was stabilized discharged on the 10th day on analgesia, antibiotics and fefol capsules.
Three weeks later, patient still complaining of left gluteal swelling and pain. Patient also started to have fever 38.8°C and spiking. On examination, there was left gluteal swelling 9*5 cm, tender with no fluctuation or hotness. Patient had an Hb of 7.4 g/dL and ESR of 45. Patient was admitted for IV antibiotics and evaluation.

    Next day, left gluteal U/S shows 10*8 cm cystic mass which demonstrate turbulence flow on C.D.U/S. (figure 1)

     Angiogram was then performed which demonstrated a large pseudo-aneurysm with a large feeder arising from the internal iliac artery. Embolization was done using coils.(figures 2,3)
 

    Two days later, patient had follow up C.D.U.S. which demonstrated complete thrombosis of the pseudo-aneurysm.(figure 4)
 

    On 7th day of admission patient’s temp returned to normal and was discharged on the 9th day on oral antibiotics and analgesia.

Discussion:
    Superior gluteal artery false aneurysm is a rare presentation. The most common causes of false aneurysm are traumatic by stab wound¹ or arterial catheterization. Other causes include post Le Fort I,III type fracture² and post internal fixation of an intertrochanteric femoral fracture³.

    False aneurysm can present early as ischemia distaly⁴, pressure symptoms⁵ or as a mass⁶. Aneurysm can be treated surgically by excision with Dacron graft replacement³, by surgical ligation⁷ or by embolization which offer an effective alternative and less invasive approach than surgery^1,8.
 
 

References:

1- Bremont O, et al. False traumatic aneurysm of the internal mammary artery caused by stab        wound. Apropos of a case. Arch Mal Coeur Vaiss 1993 Mar;86(3):377-9

2- Rogers sn, et al. Traumatic aneurysm of the maxillary artery : the role of interventional radiology. A report of two cases. Int J Oral Maxillofac Sur 1998 Oct;24(5):336-9.

3- Ebong WW. False aneurysm of the profunda femoris artery following internal fixation of an intertrochanteric femoral fracture.Injury 1978 Feb;9(3):249-51.

4- Izumiyama O, et al. A case of traumatic aneurysm of innominate artery with occlusion of right subclavian artery. Kyobu Geka 1999 Dec;52(13):1120-3.

5- Sano E. et al. A case of traumatic aneurysm of the thoracic aorta with severe chronic compression of the trachea. Kyoba Geka 1995 Feb;48(2):145-8.

6- Ramos A, et al. Traumatic aneurysm of the internal carotid : a late finding presenting as a mass in the sphenoid sinus. AJNR Am J Neuroradiol  1996 Feb;17(2):222-5.

7- Marioka T, et al. Traumatic aneurysm of the superficial temporal artery in an elderly patient. Neurosurg Rev 1997;20(4):278-81.

8- Clark S, et al. Traumatic aneurysm of the internal maxillary artery and their treatment by embolization: a report of two cases. Br J Oral Maxillofac Surg 1990 Oct;28(5):302-5.

9- Schwartz S. Principles of Surgery,7th  Ed, U.S.A. : McGraw-Hill,1999