A Case of Laparoscopic Surgery for a Ruptured Left Colic Artery Aneurysm Caused by Segmental Arterial Mediolysis

Abstract

A 36-year-old man, who was brought into a hospital for left-sided abdominal pain during a business trip abroad, was diagnosed with superior mesenteric artery occlusion of unknown cause and came home after medical treatment. His abdominal pain was persistent and he presented to our hospital. Abdominal contrast-enhanced CT scan showed dissection of the superior mesenteric artery, an aneurysm of the left colic artery and a surrounding hematoma. Angiography of the inferior mesenteric artery showed an aneurysm and irregular dilatation of the marginal artery at the splenic flexure. Transcatheter arterial embolism (TAE) was not performed because there was a high possibility of intestinal ischemia. We decided to perform semi-urgent laparoscopic left hemicolectomy. Operative findings included intraabdominal hemorrhage and extensive hematoma in the vicinity of the splenic flexure. The colon was divided from the retroperitoneum under laparoscopy. The vascular ligation was performed from a small laparotomy. The pathological diagnosis was segmental arterial mediolysis (SAM). We treated conservatively for the superior mesenteric arterial aneurysm, and one month later thrombosis of false lumen was formed. We report our experience with a case of laparoscopic assisted surgery for a ruptured left colonic artery aneurysm caused by SAM.