Abstract
A 78-year-old man was brought into our hospital by ambulance because of the abrupt onset of abdominal pain. When he arrived at our hospital, he was in shock state, blood examination revealed anemia, and the PT-INR was remarkably prolonged. Intra-abdominal hemorrhage was thus suspected. Abdominal CT scan revealed large quantities of fluid retention in the abdominal cavity. Rupture of an aneurysm at a branch from the superior mesenteric artery was considered to occur, causing hemorrhage. Angiography showed an aneurysm at the middle colic artery, so that the responsible vessel was occluded by coil embolization and emergency right hemicolectomy was subsequently performed. Upon laparotomy, bleeding from the aneurysm at the middle colic artery had already stopped and we completed the operation safely.
Abdominal visceral aneurysms are relatively rare. About half of these cases are of a splenic aneurysm, and aneurysms of the colic artery are believed to be extremely rare. In this case we could safely perform the surgery for the ruptured aneurysm of the middle colic artery after identifying the bleeding site by angiography followed by successful hemostasis by the coil embolization. Preoperative angiography and embolization appeared to be very helpful.
