Ruptured Middle Colic Artery Aneurysm in a Patient with Multiple Visceral Artery Aneurysms

Atsuro Niwa, Takamaori Mitsui, Satoru Moriyama, Hideyuki Ishiguro, Hiroe Yanase, Toshinobu Oowa, Kazuo Shibata, Shingi Sasaki, Hidehiko Tsunooka

Department of Surgery, Toyokawa City Hospital

A case of ruptured middle colic artery aneurysm in a patient with multiple visceral artery aneurysms is reported. A 60-year-old man with a history of hypertension was admitted to our hospital with severe abdominal pain and back pain of sudden onset. On the initial examination, he was found to have moderate abdominal tenderness and laboratory studies showed leukocytosis. Ultrasonography revealed a fluid collection in the abdominal cavity, and abdominal paracentesis revealed free blood. CT scan showed hemoperitoneum, mesenteric hematoma and a splenic artery aneurysm. A tentative diagnosis of massive hemorrhage probably arising from a ruptured aneurysm of the splenic artery or an adjacent artery was made. Emergency operation was performed, and massive bleeding from a ruptured aneurysm of the left branch of the middle colic artery was identified. The affected vessel was ligated proximally and distally, and removed. Pathologic examination revealed a dissecting aneurysm due to medical necrosis. The postoperative course was uneventful, and the patient was discharged on the 16th postoperative day. Postoperative arteriography showed an occluded celiac artery and multiple aneuryms involving the superior mesenteric artery, the pancreaticoduodenal artery, the dorsal pancreatic artery, the splenic artery, the gastroduodenal artery, and the middle colic artery. No symptoms or signs attributable to the residual aneuryms occurred during the 18-month period following discharge.

Key words
middle colic artery aneurysm, visceral artery aneurysm, celiac artery occlusion

Reprint requests
Atsuro Niwa Department of Surgery, Toyokawa City Hospital
1-19 Koumei-cho, Toyokawa, 442 JAPAN

Accepted
April 23, 1997

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