Lateral sacral artery aneurysm

Area of Science:

• Vascular Surgery
• Neurology
• Radiology

Background:

• Aneurysms of the lateral sacral artery are exceptionally rare vascular abnormalities.
• Patients with a history of renal transplant may present with complex conditions requiring comprehensive diagnostic approaches.

Observation:

• A 46-year-old female with a history of renal transplant presented with cauda equina syndrome symptoms, including bowel/bladder incontinence and decreased perianal sensation.
• During attempted laminectomy and diskectomy for a presumed prolapsed disk, severe intraoperative hemorrhage occurred, leading to surgical abortion.

Findings:

• Magnetic resonance imaging and angiography confirmed a lateral sacral artery aneurysm as the likely cause of the hemorrhage.
• The aneurysm presented as a diagnostic challenge, mimicking or complicating the presentation of a prolapsed lumbar disk.

Implications:

• This case underscores the necessity of considering lateral sacral artery aneurysms in the differential diagnosis for patients presenting with cauda equina syndrome, particularly those with a history of renal transplantation.
• Thorough pre-operative assessment, including advanced imaging, is crucial for identifying such rare vascular pathologies to guide appropriate treatment strategies and prevent life-threatening hemorrhage.