A CASE OF A RUPTURED MIDDLE COLIC ARTERY ANEURYSM DUE TO SEGMENTAL ARTERIAL MEDIOLYSIS (SAM)

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  • YAMADA Masato
    Department of Surgery, Kesennuma City Hospital Division of Advanced Surgical Science and Technology Graduated School of Medicine Tohoku University
  • ITAKURA Yuko
    Department of Surgery, Kesennuma City Hospital
  • YOKOTA Kenichi
    Department of Surgery, Kesennuma City Hospital
  • WADA Naobumi
    Department of Surgery, Tohoku Kosai Hospital
  • YOKOYAMA Shigekuni
    Department of Surgery, Kesennuma City Hospital
  • ENDO Wataru
    Department of Surgery, Kesennuma City Hospital

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  • Ｓｅｇｍｅｎｔａｌ　ａｒｔｅｒｉａｌ　ｍｅｄｉｏｌｙｓｉｓが成因と考えられた中結腸動脈瘤破裂の１例

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Abstract

A 56-year-old woman complained of abdominal pain and went into shock. Abdominal computed tomography revealed the presence of a large, low-density mass located in front of the pancreas. IIematologic examination revealed an anemia ; abdominal paracentesis demonstrated the presence of blood. A clinical diagnosis of hemorrhage due to the rupture of a tumor or an aneurysm of an abdominal visceral artery was made. The patient's severe anemia persisted ; on the next day, angiography revealed an aneurysm in the middle colic artery. Therefore, emergency surgery was done. A hematoma located in the transverse colonic mesentery was noted during surgery ; the patient was subsequently diagnosed as having a hemorrhage from a ruptured 2 × 1 cm aneurysm which was located near the first branch of the middle colic artery. The aneurysm was removed after it was confirmed that the blood flow to her intestine was preserved by marginal arteries. The pathological findings were consistent with those of segmental arterial mediolysis (SAM). Computed tomography scans taken postoperatively showed that the patient did not have only other visceral aneurysms.

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