Rupture of a Left Gastroepiploic Artery Aneurysm Due to Segmental Arterial Mediolysis–A Case Report

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  • 緊急手術により救命しえたsegmental arterial mediolysis（SAM）による左胃大網動脈瘤破裂の１例

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<p>We encountered a rare case of the rupture of a left gastroepiploic artery aneurysm due to segmental arterial mediolysis. A 79-year-old man who had chest pain was transferred to our hospital due to the suspicion of angina pectoris. Based on angiocardiography, he had no severe coronary stenosis, and so we decided to admit him to the ICU without intravascular treatment. After hospitalization he was stable, but the next day he suddenly developed intense abdominal pain, and his blood pressure dropped. Computed tomography revealed the presence of ascites and the leakage of contrast medium outside of blood vessels at the central part of the gastric corpus. We diagnosed the patient with intra-abdominal hemorrhage and hemorrhagic shock caused by rupture of a gastric artery aneurysm, and decided to perform emergency surgery. During the operation, we found of the many hematomas in the abdominal cavity and active bleeding from the left gastroepiploic artery. We could stop the bleeding by partial resection of the greater omentum including the artery. Histopathologic findings indicated the presence of acute arterial dissection in the left gastroepiploic artery and marked segmental arterial mediolysis (SAM) as the background of lesions. His post-operative course was uneventful, and he was discharged on the 36th post-operative day.</p>

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