Uretero-iliac artery aneurysm fistula: A rare but fatal cause of haematuria

Visible haematuria from an uretero-iliac artery aneurysm fistula (UIAF) offers a diagnostic challenge and early accurate diagnosis can have a significant impact on prognosis. We report a 90 year old gentleman who presented with visible haematuria and clot retention. He required catheterisation, bladder washout and a blood transfusion. Subsequent imaging revealed an abdominal aortic aneurysm and bilateral iliac artery aneurysms with left sided hydronephrosis and hydroureter. There was no radiological evidence of a fistula between the left ureter and iliac aneurysm. Due to associated co-morbidity surgical intervention was not deemed suitable. Although his haematuria initially settled he developed catastrophic haematuria and died. Post-mortem confirmed UIAF causing fatal haemorrhage. In this report we discuss the diagnostic challenges and management options for this condition.