2017 Volume 26 Issue 2 Pages 139-142
A 78-year-old man underwent Y-grafting for an infrarenal abdominal aortic aneurysm. The next evening, he suddenly went into shock. Contrast computed tomography (CT) revealed a hemoperitoneum located immediately dorsal to the transverse colon. Angiography showed dilatation and stenosis of the middle colic artery with no contrast medium extravasation. Although the hemodynamics was temporarily stabilized, he went into shock again the next day. Laparotomy was urgently performed. The middle colic artery was dilated and had a 3 cm longitudinal tear. We repaired the tear with a 5-0 polypropylene running suture. The postoperative course was uneventful. He was discharged without complications after 18 postoperative days. Contrast CT and angiography suggested that rupture of middle colic artery was associated with segmental arterial mediolysis (SAM). Preceding Y-grafting might have led to SAM, even though the middle colic artery was anatomically remote.
