A Case of Segmental Arterial Mediolysis Found by Jejunal Necrosis

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  • Yoshida Kouichi
    Departments of General and Gastroenterological Surgery, Cardiovascular Surgery
  • Yamada Tetsuji
    Departments of General and Gastroenterological Surgery, Cardiovascular Surgery
  • Morita Katsuya
    Departments of General and Gastroenterological Surgery, Cardiovascular Surgery
  • Nakamura Kazuhiko
    Departments of General and Gastroenterological Surgery, Cardiovascular Surgery
  • Yagi Shingo
    Departments of General and Gastroenterological Surgery, Cardiovascular Surgery
  • Kitagawa Susumu
    Departments of General and Gastroenterological Surgery, Cardiovascular Surgery
  • Nakagawa Masaaki
    Departments of General and Gastroenterological Surgery, Cardiovascular Surgery
  • Seki Masahiro
    Departments of General and Gastroenterological Surgery, Pathology
  • Katayanagi Kazuyoshi
    Ishikawa Prefectural Central Hospital
  • Kurumaya Hiroshi
    Ishikawa Prefectural Central Hospital

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Other Title
  • 空腸壊死で発症したsegmental arterial mediolysisの1例

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Abstract

A 51-year-old man admitted with abdominal pain was diagnosed with paralytic ileus and treated conservatively. When symptoms persisted, we conducted a laparotomy and found 40 cm of the anal side from Treitz's ligament of the jejunum irregularly mottled by necrosis and conducted partial jejunectomy. Postoperative angiography showed multiple aneurysms in superior and inferior mesenteric arteries. Screening for collagen disease was negative. Blood circulation was reconstructed 43 days after the first operation. Histological evaluation showed the media of resected aneurysmal wall to be segmentally absent, leading to a diagnosis of segmental arterial mediolysis. In aneurysms of abdominal splanchnic arteries, it is important to consider screening these arteries as broadly as possible due to possible segmental arterial mediolysis and the necessity of blood circulation reconstruction.

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