Department of gastrointestinal surgery, Shinko Hospital, 1-4-47 Wakinohama-cho, Chuo-ku, Kobe, 651-0072, Japan.
Department of pathology, Shinko Hospital, 1-4-47 Wakinohama-cho, Chuo-ku, Kobe, 651-0072, Japan.
BMC Surg. 2020 Aug 27;20(1):191. doi: 10.1186/s12893-020-00849-x.
Gastric artery aneurysms are rarely caused by segmental arterial mediolysis (SAM), a condition that often involves multiple vessels. The clinical course of SAM after vessel rupture may vary depending on the involved vessels. For example, the "double-rupture phenomenon" observed following the rupture of the splenic artery aneurysm manifests as a biphasic and relatively slow clinical course. Even in cases of rupture of gastric artery aneurysm, the double-rupture phenomenon has only been reported in two cases so far. However, the rupture was not caused by SAM in either case. Herein, we present the apparent first case of a right gastric artery (RGA) aneurysm rupture caused by SAM that presented with a biphasic clinical course, possibly due to the double-rupture phenomenon.
A 54-year-old woman was transferred to the emergency department with severe abdominal pain and a cold sweat for a duration of 3 h. She had developed mild abdominal pain and nausea 3 days earlier. Her vital signs were stable. Physical examination revealed tenderness in the epigastric area. Abdominal contrast-enhanced computed tomography revealed an RGA aneurysm with contrast media extravasation. A diagnosis of hemoperitoneum following a ruptured RGA aneurysm was made, and the patient underwent angiography. However, this modality did not reveal any extravasation from the RGA due to an interruption in the peripheral branch of the artery. Nevertheless, to prevent major bleeding, we performed coil embolization at the point of interruption in the RGA, which we suspected to be a ruptured aneurysm. A distal gastrectomy with Roux-en-Y reconstruction for aneurysm resection was performed the following day. There were no postoperative complications, and the patient was discharged 17 days after surgery. Histologically, the RGA demonstrated multiple vacuoles in the medial muscle layer, which were characteristic of SAM.
An RGA aneurysm rupture should be considered a differential diagnosis in patients presenting with hemoperitoneum with a slow or biphasic clinical course.
胃动脉动脉瘤很少由节段性动脉中层溶解（SAM）引起，这种情况通常涉及多支血管。SAM 导致血管破裂后的临床病程可能因涉及的血管而异。例如，脾动脉瘤破裂后观察到的“双破裂现象”表现为双相和相对缓慢的临床过程。即使在胃动脉动脉瘤破裂的情况下，迄今为止仅报告了两例双破裂现象。然而，在这两种情况下，破裂都不是由 SAM 引起的。在此，我们报告首例由 SAM 引起的右胃动脉（RGA）动脉瘤破裂的病例，该病例表现为双相临床过程，可能是由于双破裂现象。
一名 54 岁女性因剧烈腹痛和冷汗持续 3 小时被转入急诊室。她在 3 天前出现轻度腹痛和恶心。生命体征稳定。体格检查显示上腹部压痛。腹部增强 CT 显示 RGA 动脉瘤伴造影剂外渗。诊断为 RGA 破裂引起的肝性血腹，患者接受了血管造影。然而，由于动脉周围分支中断，该方法未显示 RGA 有任何造影剂外渗。然而，为了防止大出血，我们在 RGA 的中断部位进行了线圈栓塞，我们怀疑该部位是破裂的动脉瘤。次日进行了 RGA 中断部位的 RGA 切除术和 Roux-en-Y 重建术。无术后并发症，患者术后 17 天出院。组织学上，RGA 显示中膜层有多个空泡，这是 SAM 的特征。
对于表现为慢相或双相临床过程的肝性血腹患者，应考虑 RGA 动脉瘤破裂作为鉴别诊断。
