A Surgical Case of Retroperitoneal Hematoma Associated with Rupture of Middle Colic Arterial Aneurysm

Masashi Utsumi, Atsushi Muraoka, Masahiko Kobayashi, Keigo Kimura, Yasutaka Kokudo, Akihiko Tatemoto, Makoto Tumura and Masaki Tsuruno

Department of Surgery, Kagawa Rosai Hospital

We report a patient in whom middle colic arterial rupture was diagnosed by abdominal angiography, followed by emergency surgery. A 52-year-old was seen at our emergency outpatient clinic for abdominal pain was diagnosed with acute enteritis and went home. Abdominal pain did not subside, and he revisited the following day. Retroperitoneal hemorrhage was diagnosed by CT, and angiography indicated a middle colic arterial aneurysm accompanied by extravasation. Since hemostasis by transcatheter arterial embolization was difficult, we conducted emergency surgery. A marked hematoma that had formed in the retroperitoneum was found on laparotomy and diagnosed as hematoma associated with aneurysm rupture near the first branch of the middle colic artery, and the aneurysm was removed. Pathologically, the tunica intima and media were necrotic, suggesting involvement of segmental arterial mediolysis (SMA). This is a rare case, with few previous reports. IVR is the first choice of treatment because diagnosis and therapy can be done simultaneously, but laparotomy may be preferable, depending on the condition.

Key words
middle colic arterial aneurysm, segmental arterial mediolysis

Reprint requests
Masashi Utsumi Department of Surgery, Kagawa Rosai Hospital
3-3-1 Jyotou-cho, Marugame, 763-8502 JAPAN

Accepted
May 31, 2006

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