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Faecaloma causing large bowel obstruction: a case report and review of literature

neurysm occurs when the integrity of the vessel is compromised, leading to extravasation and haematoma formation in the surrounding tissues. The suprascapular artery is vulnerable to such injury following fractures of the scapula or clavicle given the close proximity to these bony structures. Suprascapular pseudoaneurysms are infrequently reported in the literature. Presentation is most commonly with pain and a soft tissue swelling, which may or may not be pulsatile. It may rarely present with torticollis. Several case reports highlight a delay in presentation after blunt thoracic trauma, which may be, as in this case, several years after the original injury. Recent anticoagulation may have unmasked this previously undiagnosed arterial injury. Therefore, the main learning point from this case is that a low index of suspicion is required for pseudoaneurysm bleed when patients present with such a haematoma on a background of scapular trauma, even if there has been a considerable passage of time from the event. The diagnosis is typically confirmed with imaging, either duplex ultrasound, CTA or magnetic resonance angiogram. Optimal management of such cases remains unclear but endovascular embolization in selected patients may be successful in alleviating symptoms. Although there are no case reports of suprascapular artery pseudoaneurysm rupture, it remains a potentially life threatening consequence. Several recent case reports demonstrate successful selective endovascular embolization of selected thyrocervical trunk arterial branches with either microcoils, liquid polymer or ultrasound-guided thrombin injection. Long-term outcomes, however, remain unknown. In our case, the risks of pursing a technically challenging embolization of a small suprascapular artery pseudoaneurysm were felt to outweigh the risks of rupture and so a conservative approach, with interval CTA surveillance, was favoured.