A dangerous entrapment: pelvic aneurysms causing hydronephro
The present case has been reported in the American Journal of Medicine.

A 75-year-old patient with end-stage kidney disease on chronic hemodialysis was admitted with fever and rigor. He was a heavy smoker and had long-standing diabetes and hypertension with abdominal aortic aneurysm (repaired 16 years prior with aortobifemoral graft) and peripheral artery disease with left above-knee amputation.

Soon after admission, his blood pressure dropped and he required pressor support and meropenem/vancomycin coverage. Blood tests suggested sepsis with disseminated intravascular coagulation (neutropenia, thrombocytopenia), and cultures grew Citrobacter koseri without source of infection on examination, x-ray study, or echocardiography.

CT with contrast revealed right hydroureteronephrosis owing to pelvic compression by a 13-cm aneurysm of the iliac artery shifting the urinary bladder to the right. The hydronephrotic sac appeared infected and was aspirated, yielding pus positive for gram-negative bacilli identified as C. koseri. A right nephrostomy tube was inserted. The patient stabilized.

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