Two Cases of Spontaneously Ruptured Aneurysms of the Middle Colic Artery Due to Segmental

• Published in: Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 33; no. 3; pp. 631 - 635
• Main Authors: Kobayashi, Katsumi, Tomizawa, Naoki, Arakawa, Kazuhisa, Sunose, Yutaka, Takeyoshi, Izumi
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society for Abdominal Emergency Medicine 31.03.2013
• Subjects: Segmental arterial mediolysis (SAM)
• ISSN: 1340-2242; 1882-4781
• DOI: 10.11231/jaem.33.631

This paper presents two cases of spontaneously ruptured aneurysms of the middle colic artery due to segmental arterial mediolysis (SAM). Case 1, a 60-year-old man, was admitted to our hospital in an emergency because of abdominal pain. Abdominal computed tomography (CT) revealed fluid collection in the abdominal cavity and mesenteric hemorrhage. Emergency angiography showed extravasation from an aneurysm of the middle colic artery. Emergency surgery was performed, which revealed bleeding from the left branch of the middle colic artery. The affected vessel was ligated and the transverse colon was partially resected. Case 2, a 55-year-old woman, complained of abdominal pain and went into shock. Abdominal CT was performed because her blood pressure rose in response to primary infusion. The patient went into shock again after the CT examination, therefore, emergency surgery was performed after intubation and intra-aortic balloon occlusion to maintain the blood pressure. The origin of the hemorrhage was difficult to determine, but we assumed that the mesenteric hemorrhage had developed from a branch of the middle colic artery within the transverse colon, and ligated the root of the middle colic artery and resected the left half of the colon in which the mesenteric hemorrhage was located. In both cases, pathological findings indicated destruction and dissociation of the internal elastic lamina with hemorrhage; therefore, both patients were diagnosed as having spontaneously ruptured aneurysms due to SAM.