Hypogastric artery aneurysm: survival after rupture into the rectum

We have described a 70-year-old man with rupture of a previously ligated hypogastric aneurysm. The first operation for multiple abdominal aneurysms was an aorto-bifemoral bypass with endoaneurysmorrhaphy of bilateral iliac aneurysms and proximal ligation of a right hypogastric artery aneurysm. Five months later, after the previously ligated hypogastric artery aneurysm ruptured into the rectum, endoaneurysmorrhaphy and suture ligation of all feeding orifices, creation of a Hartmann's pouch, and end-on colostomy were done. The patient is doing well at nine months' follow-up. We recommend aggressive surgical ablation of hypogastric artery aneurysms, with endoaneurysmorrhaphy and suture ligation of all "feeding" orifices.