Sakuraba Shunsuke, Orita Hajime, Ueda Shuhei, Tokuda Satoshi, Ito Tomoaki, Kushida Tomoyuki, Sakurada Mutsumi, Maekawa Hiroshi, Wada Ryo, Sato Koichi
Department of Surgery, Juntendo Shizuoka Hospital, Shizuoka, Japan.
Department of Pathology, Juntendo Shizuoka Hospital, Shizuoka, Japan.
Case Rep Gastrointest Med. 2017;2017:3634967. doi: 10.1155/2017/3634967. Epub 2017 Nov 23.
Although segmental arterial mediolysis (SAM) has been increasingly recognized as arteriopathy and there are some case reports about SAM, it is still very rare. It is characterized clinically by aneurysm, dissection, stenosis, and occlusion within splanchnic arterial branches, causing intra-abdominal hemorrhage or bowel ischemia. Mortality is as high as 50% in acute events.
A 51-year-old man was referred to our hospital with hematemesis. Gastroscopy revealed a submucosal-like tumor on the posterior wall of gastric angle with ulceration. Computed tomography indicated a tumor measuring 65 × 50 mm in the stomach, which was suspected to have invaded into the pancreas. Significant hematemesis recurred; the patient developed shock and underwent emergency distal gastrectomy, distal pancreatectomy, and splenectomy. The pathology and the clinical course were compatible with SAM splenic artery rupture causing retroperitoneal hemorrhage that penetrated into the stomach. After that surgery, aneurysm of common hepatic artery ruptured and coil embolization was performed.
SAM is an important cause of intra-abdominal or retroperitoneal hemorrhage in patients without underlying disease. SAM typically presents as intra-abdominal hemorrhage, but, in this case, the retroperitoneal hemorrhage penetrated into the stomach and it looked like a submucosal tumor.
尽管节段性动脉中层溶解（SAM）已越来越被视为一种动脉病变，并且有一些关于SAM的病例报告，但它仍然非常罕见。其临床特征为内脏动脉分支内出现动脉瘤、夹层、狭窄和闭塞，可导致腹腔内出血或肠缺血。急性事件中的死亡率高达50%。
一名51岁男性因呕血被转诊至我院。胃镜检查发现胃角后壁有一个类似黏膜下肿瘤伴溃疡。计算机断层扫描显示胃内有一个大小为65×50 mm的肿瘤，怀疑已侵犯胰腺。再次发生大量呕血；患者出现休克，接受了急诊远端胃切除术、远端胰腺切除术和脾切除术。病理及临床过程符合SAM脾动脉破裂导致腹膜后出血并穿透至胃。那次手术后，肝总动脉瘤破裂并进行了弹簧圈栓塞术。
SAM是无基础疾病患者腹腔内或腹膜后出血的重要原因。SAM通常表现为腹腔内出血，但在本病例中，腹膜后出血穿透至胃，看起来像一个黏膜下肿瘤。
