A Case of Segmental Arterial Mediolysis Found by Jejunal Necrosis

Kouichi Yoshida, Tetsuji Yamada, Katsuya Morita, Kazuhiko Nakamura, Shingo Yagi, Susumu Kitagawa, Masaaki Nakagawa, Masahiro Seki¹⁾, Kazuyoshi Katayanagi²⁾ and Hiroshi Kurumaya²⁾

Departments of General and Gastroenterological Surgery, Cardiovascular Surgery¹⁾
and Pathology²⁾, Ishikawa Prefectural Central Hospital

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.

Key words
segmental arterial mediolysis, aneurysm, acute abdomen

Reprint requests
Kouichi Yoshida Department of Surgery, Anamizu General Hospital, TA-8 Kawashima, Hugeshi-gun, Ishikawa Pref, 927-0027 JAPAN

Accepted
December 12, 2001

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