This article presents the case of a 58-year-old woman who presented feeling unwell with pain in the right upper abdomen for three days. She had a history of splenic infarcts, was on lifelong warfarin and had recently returned from a trip to Gambia. She was admitted to the hospital under suspicion of sepsis of unknown origin, and a CT scan later revealed haemoperitoneum along with a pseudoaneurysm of the right colic artery. After initially responding to resuscitation, the patient deteriorated haemodynamically, and a decision was made to perform a laparotomy, revealing a ruptured right colic artery pseudoaneurysm. In this article, the authors highlight the challenges of managing a complex unwell patient with a ruptured right colic artery pseudoaneurysm, emphasising the importance of a multi-disciplinary team approach and shared decision-making and reviewing the available literature.

Sickle cell anemia and thalassemia are hemoglobinopathies rarely encountered in the United States. Compounded with congenital heart disease, patients with sickle cell disease (SCD) requiring cardiopulmonary bypass and open-heart surgery represent the proverbial \"needle in the haystack\". As such, there is some trepidation on the part of clinicians when these patients present for complex cardiac surgery. SCD is an autosomal, recessive condition that results from a single nucleotide polymorphism in the β-globin gene. Hemoglobin SS molecules (HgbSS) with this point mutation can polymerize under the right conditions, stiffening the erythrocyte membrane and distorting the cellular structure to the characteristic sickle shape. This shape change alters cellular transit through the microvasculature. As a result, circumstances such as hypoxia, hypothermia, acidosis or diminished blood flow can lead to aggregation, vascular occlusion and thrombosis. Chronically, SCD can give rise to multiorgan damage secondary to hemolysis and vascular obstruction. This review and case study details an 11-year-old African-American male with known SCD who presented to the cardiothoracic surgical service with congenital heart disease consisting of an anomalous, intramural right coronary artery arising from the left coronary sinus for surgical consultation and subsequent surgical correction. This case report will include a review of the pathophysiology and current literature regarding preoperative, intraoperative and postoperative management of SCD patients.