2025 Volume 28 Issue 5 Pages 834-840
Segmental arterial mediolysis (SAM) often causes intra-abdominal or retroperitoneal hemorrhage, but rarely gastrointestinal (GI) bleeding. A man in his 60s had melena 10 days prior and was subsequently transferred to a local emergency hospital 4 days prior because of immobility. Severe anemia was diagnosed, and contrast-enhanced computed tomography revealed a suspected hematoma around the pancreas and duodenum. Although upper GI endoscopy was performed, no obvious bleeding was observed. Consequently, the patient was transferred to our emergency center for further investigation. Angiography performed on the same day revealed an anterior inferior pancreaticoduodenal artery with an aneurysm and narrow irregular vessels, which was considered as a hemorrhage caused by SAM. Arterial embolization was performed, and hemostasis was achieved. No progression of anemia or rebleeding was observed after embolization; therefore the patient was transferred to his attending physician on the second day of his illness. In this case, the intestinal wall distal to the duodenum was thinning at the site of an extensive aneurysm, which ruptured and caused duodenal bleeding. This case indicates that SAM may be a possible cause for upper GI bleeding in which the source of bleeding cannot be identified by GI endoscopy, especially bleeding beyond the duodenum.
