A study on 20 cases of segmental arteial mediolysis(sam) with multiple aneurysms—with a special reference to incidence, treatment and prognosis

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 69; no. 12; pp. 3101 - 3106
• Main Authors: INADA, Kiyoshi, IKEDA, Tsuneko, HAYASHI, Toshiyuki
• Format: Journal Article
• Language: Japanese
• Published: Japan Surgical Association 2008
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.69.3101

Among 56 cases of segmental arterial mediolysis (SAM), 20(35.7%) cases which were associated with multiple aneurysms were enrolled in this study examining the treatment and prognosis. Their average age was 57.8 years, and the male-to-female ratio was 14 : 6. Eighteen out of the 20 patients presented with intra-abdominal bleeding, one patient with peritonitis, and the remaining one was asymptomatic. The numbers of aneurysms were two in 13 cases, three in two, more than four in four, and 20 in one. The most commonly affected artery was the middle colic artery in nine, followed by the gastroepiploic in three among 20 ruptured aneurysms. Sixteen patients underwent emergency laparotomy and all patients survived except one who died of underlying disease. Transverse colectomy in five, right hemicolectomy in one, gastrectomy in two, and resection of the jejunum and pancreatoduodenectomy in each one were performed. Excision of seven aneurysms was performed in six patients. Unruptured aneurysms were embolized in four cases, while they were left intact in 11 cases, but the prognosis was good in all cases. A patient who had two aneurysms, one ruptured and one nonruptured, and was operated on in two stages was described. The first choice of the treatment for SAM is interventional approach although emergency laparotomy provides good therapeutic outcomes.