title: A hybrid approach to appendicitis with right external iliac artery pseudo aneurysm: A case report.
abstract: BACKGROUND
  While acute appendicitis is a common surgical problem, the simultaneous occurrence of appendicitis and an infected iliac artery pseudoaneurysm is exceedingly rare. We report the successful treatment of an infected right external iliac artery pseudo aneurysm in the 1setting of acute appendicitis.
  
  
  METHODS
  The patient is an 83-year-old male who presents with severe sepsis, right lower quadrant and right leg pain. Additional past medical history is significant for rectal cancer status post resection and radiation therapy in 1997. Computed tomography (CT) on admission revealed a right iliopsoas muscle abscess, an inflamed Appendix and a pseudo aneurysm arising from the right external iliac artery. After consultations by multiple specialties, the plan was to proceed with percutaneous drainage of the abscess, antibiotic therapy and subsequent repair of the pseudoaneurysm. CT guided drainage of the iliopsoas abscess was performed with return of hemorrhagic fluid. Due to the concern of contained pseudoaneurysm rupture, the patient was taken for expedited repair. Due to the patient's frailty and hostile abdomen, we performed embolization of the right external iliac artery pseudoaneurysm with Amplatzer I plugs (St. Jude Medical, St. Paul MN) and left common femoral to right superficial femoral bypass with cryopreserved cadaveric femoral vein. Following pseudoaneurysm exclusion, continued percutaneous drainage and antibiotic therapy, the patient has done well with no further evidence of infection.
  
  
  CONCLUSIONS
  Repair of infected pseudo aneurysms can prove challenging. Ongoing infection, a hostile surgical abdomen and patient frailty further complicates the treatment of these patients. This case displays a minimally invasive approach to this rare but morbid condition.
authors.affiliation: Department of Vascular and Endovascular Surgery, Geisinger Medical Center, Danville, PA, United States.
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Chandler
authors.affiliation: Department of Vascular and Endovascular Surgery, Geisinger Medical Center, Danville, PA, United States. Electronic address: ejryer@geisinger.edu.
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Ryer
authors.affiliation: Department of Vascular and Endovascular Surgery, Geisinger Medical Center, Danville, PA, United States.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Keyser
authors.affiliation: Department of Vascular and Endovascular Surgery, Geisinger Medical Center, Danville, PA, United States.
authors.forename: James R
authors.initials: JR
authors.lastname: Elmore
keywords: Appendicitis; Iliac artery reconstruction; Iliopsoas muscle abscess; Mycotic aneurysm; Pseudoaneurysm