Leaking left hypogastric artery aneurysm causing bilateral ureteric obstruction.

Area of Science:

• Urology
• Vascular Surgery
• Radiology

Background:

• Pelvic hematomas can cause significant genitourinary complications.
• Hypogastric artery aneurysms are rare but potentially life-threatening vascular conditions.

Observation:

• A 64-year-old man presented with acute bilateral flank pain and bilateral ureteral obstruction.
• Imaging revealed a pelvic hematoma compressing the lower ureters and displacing the bladder anteriorly.
• Cystoscopy confirmed pulsatile anterior displacement of the bladder base.

Findings:

• The pelvic hematoma originated from a leaking left hypogastric aneurysm.
• Intravenous pyelogram demonstrated ureteral narrowing, hydroureteronephrosis, and bladder displacement.
• Arteriography confirmed the aneurysm and guided successful surgical ligation.

Implications:

• This case highlights the importance of considering vascular emergencies in genitourinary presentations.
• Prompt diagnosis and intervention, including surgical ligation, are crucial for managing leaking hypogastric aneurysms.
• Understanding the anatomical relationship between pelvic hematomas and ureteral obstruction is vital for effective treatment.