Management of a Ruptured Giant Isolated Iliac Aneurysm; A Rare Entity: A Case Report

Isolated iliac artery aneurysms are rare and usually asymptomatic until rupture, which carries a high mortality. Their deep pelvic location makes clinical detection difficult, and diagnosis is often incidental. We report the case of a 75-year-old man with insulin-treated type 2 diabetes and benign prostatic hyperplasia, in whom a pelvic CT scan incidentally revealed a giant iliac aneurysm. Initial examination found no pulsatile mass. During hospitalization, he developed abdominal pain, hematuria and hemorrhagic shock. Emergency CT angiography showed a partially thrombosed 60 × 50 mm saccular aneurysm of the common iliac artery with signs of rupture. He underwent emergency aortoiliac bypass with aneurysm exclusion and internal iliac artery ligation, but died in intensive care from refractory shock and multiorgan failure. This case highlights the high mortality of emergency repair compared with elective repair. Early detection and elective treatment of aneurysms larger than 3.5 to 4 cm, preserving internal iliac flow when feasible, are essential to improve outcomes.