Melaena: an unusual presentation of a pseudoaneurysm of the internal carotid artery

Tan VKM, Tan HH, Ong YK, Tan SG
Correspondence: Dr Veronique KM Tan, vquetan@gmail.com

ABSTRACT
Pseudoaneurysm of the internal carotid artery is a rare but potentially fatal condition, and its clinical manifestations are often varied. Knowledge of this condition is essential to making the diagnosis. We describe a case of a 38-year-old man who presented with melaena. He also reported blood-stained sputum in the morning for several days. The only significant physical finding was a left peritonsillar mass. Initially worked up for a gastrointestinal bleed, computed tomography of the neck showed a large pseudoaneurysm of the internal carotid artery. A bypass from the proximal external carotid artery to the distal middle cerebral artery had to be created prior to angiographic embolisation of the pseudoaneurysm due to an inadequate supply from the contralateral cerebral hemisphere. The patient made an uneventful recovery with no neurological deficits.

Keywords: endovascular embolisation, extracranial-intracranial bypass, internal carotid artery, melaena, pseudoaneurysm
Singapore Med J 2008; 49(11): e296-e299