Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2015; 7(5): 78-81
Published online May 27, 2015. doi: 10.4240/wjgs.v7.i5.78
Pancreatectomy and splenectomy for a splenic aneurysm associated with segmental arterial mediolysis
Yasuhiro Matsuda, Kazuki Sakamoto, Eisei Nishino, Naoki Kataoka, Tomoyuki Yamaguchi, Masafumi Tomita, Arito Kazi, Masahiro Shinozaki, Shinichiro Makimoto
Yasuhiro Matsuda, Kazuki Sakamoto, Naoki Kataoka, Tomoyuki Yamaguchi, Masafumi Tomita, Shinichiro Makimoto, Department of Surgery, Kishiwada Tokushukai Hospital, Osaka 596-8522, Japan
Eisei Nishino, Department of Pathology, Kishiwada Tokushukai Hospital, Osaka 596-8522, Japan
Arito Kazi, Masahiro Shinozaki, Department of Emergency and Critical Care Medical Center, Kishiwada Tokushukai Hospital, Osaka 596-8522, Japan
Author contributions: Matsuda Y, Sakamoto K and Nishino E designed the report and wrote the paper; Kataoka N, Yamaguchi T, Tomita M, Kazi A, Shinozaki M and Makimoto S provided treatment.
Supported by The Department of Surgery, Kishiwada Tokushukai Hospital, Osaka, Japan.
Ethics approval: The study was reviewed and approved by the Institutional Review Board of Kishiwada Tokushukai Hospital for ethical issues.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: We certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yasuhiro Matsuda, MD, Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-chou, Kishiwada City, Osaka 596-8522, Japan. my-salsa@air.ocn.ne.jp
Telephone: +81-72-4459915 Fax: +81-72-4459791
Received: September 2, 2014
Peer-review started: September 4, 2014
First decision: February 7, 2015
Revised: February 23, 2015
Accepted: March 16, 2015
Article in press: March 18, 2015
Published online: May 27, 2015
Abstract

Segmental arterial mediolysis (SAM) is characterized by intra-abdominal, retroperitoneal bleeding or bowel ischemia, and the etiology is unknown. A 44-year-old man complaining of abdominal pain was admitted to our hospital. He had been admitted for a left renal infarction three days earlier and had a past medical history of cerebral aneurysm with spontaneous remission. The ruptured site of the splenic arterial aneurysm was clear via a celiac angiography, and we treated it using trans-arterial embolization. Unfortunately, the aneurysm reruptured after two weeks, and we successfully treated it with distal pancreatomy and splenectomy. We recommended a close follow-up and prompt radiological or surgical intervention because SAM can enlarge rapidly and rupture.

Keywords: Re-rupture, Segmental arterial mediolysis, Trans-arterial embolization, Spontaneous remission, Splenic artery aneurysm

Core tip: Segmental arterial mediolysis (SAM) related to intra-abdominal, retroperitoneal bleeding or bowel ischemia has a mortality approaching 25%-50%. We treated the splenic artery aneurismal re-rupture associated with SAM after trans-catheter arterial embolization with a distal pancreatomy and splenectomy. We recommend close follow-ups and prompt radiological or surgical intervention because SAM can increase rapidly and rupture.