A Case of Spontaneously Ruptured Aneurysm of the Middle Colic Artery which was diagnosed by Preoperative Computed Tomography Successfully treated by an Emergency Surgery

• Published in: Nippon Shokaki Geka Gakkai zasshi Vol. 41; no. 1; pp. 146 - 151
• Main Authors: Oguma, Junya, Aoki, Masahiko, Hosoda, Kei, Kido, Hiromu, Natsu, Kingen, Tamura, Hikaru, Amemiya, Tetsu
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 2008
• Subjects: emergency surgery; hematoma in the mesenterium; spontaneously ruptured aneurysm of the middle colic artery
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.41.146

A 62-year-old man reporting upper abdominal pain and found in abdominal ultrasonography to have fluid collection was further found in abdominal computed tomography (CT) to have the second branch of the middle colic artery was dilated with fluid collecting in the abdominal cavity. Although we suspected hemorrhage due to the rupture of an aneurysm in the middle colic artery, no contrast medium leaked into the abdominal cavity and his vital signs were stable, so we followed a strict conservative strategy. After admission, his blood pressure suddenly fell, however, and he became unconscius. Abdominal CT conducted again showed that hematoma in the abdominal cavity increased. We diagnosed hemorrhagic shock due to aneurysm rupture in the middle colic artery necessitately emergency surgery. We confirmed that the origin of the hemorrhage was an aneurysm in the second branch of the middle colic artery, which we ligated and cut. We also segmentally resected the left side of transverse colon fed by this artery, because colonic wall of this area looked pale gradually. Finally, We performed ileostomy. The postoperative course was uneventful. Because we could confirmthe existence of the aneurysm in preoperative CT, we determined that emergency surgery would be appropriate in treating the great hematoma volume.