Paediatric bulbar artery pseudoaneurysm: an uncommon cause for urethrorrhagia
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LETTER TO THE EDITOR
Paediatric bulbar artery pseudoaneurysm: an uncommon cause for urethrorrhagia A. L. Scarlett1 · P. Patel2 · I. Mushtaq2 · Nishat Rahman1 Received: 20 April 2020 / Accepted: 24 April 2020 © Springer Nature Singapore Pte Ltd 2020
Dear Editor, Post-operative haematuria in urological patients is not infrequent and commonly resolves without significant intervention. Aetiology is varied but is often inflammatory or traumatic in nature. Pseudoaneurysm (PA) formation within the paediatric population is rarely reported [1] and can provide a diagnostic dilemma. A 15-year-old boy had an extensive history of chronic disease, including eosinophillic colitis with refractory constipation. For this, he underwent multiple pelvic surgeries including end-ileostomy formation, completion proctectomy and excision of mucocele complicated by perineal wound dehiscence. A vesicostomy button was inserted for management of primary nocturnal enuresis to facilitate healing of the perineal wound. Four years after insertion, and resolution of symptoms, a two-layer vesicostomy closure was performed and the boy was discharged home on post-operative day 2. On day 7, he was re-admitted with profuse bleeding per urethra and haemovolaemic compromise. Following fluid resuscitation and blood products, an 18Fr 3-way urethral catheter was inserted and thorough bladder washout performed. There was a considerable amount of fresh blood passing alongside the catheter. Serial renal tract ultrasonography revealed a variably sized bladder clot but no focal lesions. He was managed conservatively with bladder irrigation. Two weeks later, a cystoscopy demonstrated a normal urethra, “a small bladder clot”, healthy vesicostomy closure site and no active bleeding. He was discharged home with resolution of the bleeding. * Nishat Rahman [email protected] 1
Chelsea and Westminster NHS Foundation Trust Hospital, 369 Fulham Road, London SW10 9 NH, UK
Great Ormond Street NHS Foundation Trust Hospital, Great Ormond Street, London WC1N 3JH, UK
2
Unfortunately, he represented less than 24 h later with further massive urethral bleeding and clot retention, so bladder irrigation was reinstated. Subsequently repeat cystoscopy demonstrated two areas of urethral fresh bleeds in the region of the bulbar urethra. The bleeding points were cauterised. A computed tomography angiogram suggested a small arterial phase bleed in the bulbar region of the penis. He was referred to the paediatric interventional radiology team who successfully performed a gelfoam slurry embolisation of a right bulbar artery pseudoaneurysm (Fig. 1), via the contralateral common femoral artery. On day 3 postembolisation, he was discharged home with no further bleeding. He remains well after 12 months follow-up. Although rare, PAs are well described as “an extravasation of blood with disruption of arterial continuity,” [1–3] but unlike ‘true’ aneurysms, the sac contains no vascular wall components [2, 3]. Most are secondary to trauma, resulting in subtotal damage to the adventi
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