Usefulness of Preoperative Diagnostic Imaging in a Case of Segmental Arterial Mediolysis Treated Surgically

Abstract

A 52-year-old man visited a nearby clinic with a chief complaint of abdominal pain. During the examination, he went into shock and was transported to our hospital. An enhanced abdominal computed tomography (CT) examination revealed an 8-mm aneurysm of the accessory middle colic artery with massive intra-abdominal hemorrhaging. Abdominal angiography showed an aneurysm of the accessory middle colic artery with a string-of-beads appearance. Surgical management was selected due to the risk of intestinal necrosis associated with transcatheter arterial embolization. Partial resection of the colon was performed, including the resection of the abnormal vessels. The hematoma in the mesocolon actually helped us to recognize the line of separation and thereby avoid any confusion during surgery. A histopathological examination revealed segmental mediolysis of the artery and aneurysms, indicating segmental arterial mediolysis. The preoperative diagnostic imaging findings obtained in the present case enabled the surgical management to be performed correctly.