2016 Volume 36 Issue 7 Pages 1249-1253
We report the case of a patient with intraperitoneal bleeding probably caused by segmental arterial mediolysis(SAM)of the right colic artery, as suggested by postoperative three-dimensional computed tomography-angiography(3D-CTA). A 58-year-old man with a history of abdominal pain and sudden transient loss of consciousness was referred to our hospital. The symptoms recurred at our hospital, and computed tomography revealed a massive intraperitoneal fluid collection and extravasation of contrast medium from the right colic artery. Emergency laparotomy was performed to identify the cause of the intraperitoneal bleeding. 3D-CTA performed on postoperative day 2 revealed multiple bead-like dilatations of the residual branch of the right colic artery, which was found to have disappeared spontaneously in a CT repeated 10 months later. On the basis of the findings, the patient was diagnosed as a case of SAM. With the spread of the disease concept of SAM, the number of case reports is increasing. On the other hand, the pathogenetic mechanism is yet to be clearly elucidated. 3D-CTA is a useful for screening and following up the characteristics of SAM.
