Ruptured Superior Mesenteric Artery Pseudoaneurysm With Hemorrhagic Shock Secondary to Infectious Colitis: A Case Report

TL;DR

A rare case of a ruptured blood vessel in the abdomen caused severe bleeding and complications in a patient with infectious colitis.

Contribution

This case report highlights an unusual progression from infectious colitis to a life-threatening vascular complication.

Findings

A 66-year-old patient with infectious colitis developed a ruptured SMA pseudoaneurysm leading to hemorrhagic shock.

Early recognition and multidisciplinary management were critical in preventing further catastrophic outcomes.

The case underscores the importance of considering vascular complications in colitis patients with shock or bleeding.

Abstract

Superior mesenteric artery (SMA) pseudoaneurysms are rare, life-threatening vascular abnormalities most often linked to trauma, infection, or iatrogenic injury. Rupture can cause massive hemorrhage and bowel hypoperfusion. We report a unique case of SMA pseudoaneurysm rupture in the setting of infectious colitis, complicated by secondary ischemic colitis. A 66-year-old female with a history of diverticulitis initially presented to the emergency department with abdominal pain and diarrhea, and CT imaging demonstrated non-specific colitis. She was discharged in stable condition with outpatient supportive therapy, but returned three days later with worsening symptoms and hemodynamic instability. CT angiography revealed a ruptured SMA pseudoaneurysm with active intraperitoneal bleeding. Urgent transcatheter embolization was performed, but she subsequently developed bowel ischemia and perforation requiring multiple operations, including right colectomy and small bowel resection. Following a prolonged ICU course, she was ultimately discharged to long-term acute care in stable condition. This case highlights an unusual progression from infectious colitis to vascular catastrophe, followed by ischemic colitis. Early recognition of the potential for septic versus hemorrhagic shock in infectious colitis with hypotension, along with CT angiography and coordinated multidisciplinary management, was critical. Clinicians should maintain suspicion for vascular complications in colitis patients who present with hemorrhage or shock, as early diagnosis and intervention may prevent catastrophic outcomes.

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