Bleeding pseudoaneurysm of the internal iliac artery after extended resection for advanced rectal cancer: report of two cases

The incidence of locally advanced rectal cancer at diagnosis has increased despite surveillance programmes, especially among young patients. Extended low anterior resection and pelvic exenteration after chemoradiotherapy have been described to be effective treatments for advanced primary or recurrent pelvic cancer although they are recognised to be technically demanding procedures associated with high morbidity and mortality rate. Bleeding represents one of the most serious peri-operative complications, especially during pelvic exenteration. Secondary haemorrhage is much less common; to date, ruptured pseudoaneurysm of the pelvic arteries has not been described as a cause of massive postoperative rectal bleeding after surgery for advanced rectal cancer.