Inpatient Consult

43 year old patient with recent diverting ileostomy now presenting with altered mental status, drop in hemoglobin, and persistent oozing around the ileostomy site. A CT abdomen and pelvis examination is obtained for further evaluation.

CTA showed a pseudoaneurysm arising from the right inferior epigastric artery.

Reasonable options include transarterial embolization and percutaneous thrombin injection. Percutaneous thrombin injection was selected.

A 25G spinal needle was advanced into the aneurysm sac under ultrasound guidance followed by injection 100 units of thrombin resulting in complete thrombosis of the targeted aneurysm.

This often requires only a small amount of thrombin. If injecting more than 1000 units, it is worth pausing and making sure the thrombin is going only where intended rather than out into the feeding artery or through an arteriovenous fistula.

Learn More

• BackTable Demo for how to mix thrombin for pseudoaneurysm injections

• Retrospective study of success of percutaneous thrombin injection