Abstract
An 86-year-old woman with a chief complaint of sudden lower abdominal pain and vomiting was transported by ambulance to our hospital. CT showed ascites and extravasation of contrast medium into the peritoneum from blood vessels at the greater curvature of the stomach. Hemoperitoneum was diagnosed, and emergency surgery was performed.
During laparotomy, a large hematoma in the greater omentum along the greater curvature of the stomach was noted. In addition, active bleeding from right gastroepiploic vessels near the hematomas was observed. Rupture of a right gastroepiploic artery aneurysm was diagnosed. A partial greater omentectomy, including the aneurysm, was performed, and the patient's postoperative course was good. Histopathology showed that the cause of the ruptured aneurysm was segmental arterial mediolysis (SAM).
SAM has recently been reported to be involved in many dissecting visceral artery aneurysms. However, gastroepiploic artery aneurysms due to SAM have seldom been reported. Ruptured visceral artery aneurysms due to SAM should be kept in mind in the differential diagnosis of an acute surgical abdomen. This is an indication for surgery that requires prompt assessment, including a search for multiple lesions.
