Ito Chikao, Koyama Tomohide, Fujimori Daisuke, Takahashi Isao, Kasuya Miyuki, Oe Kyoji, Sakamoto So, Yoshida Ryuhei, Yoshiike Hidetaka, Ito Masaaki, Yamashita Wataru, Watanabe Sho, Isogai Jun
Department of Emergency Medicine Asahi General Hospital Chiba Japan.
Department of Radiology Asahi General Hospital Chiba Japan.
Acute Med Surg. 2023 Oct 7;10(1):e899. doi: 10.1002/ams2.899. eCollection 2023 Jan-Dec.
We describe a case of segmental arterial mediolysis in which a vessel ruptured on two consecutive days.
A 69-year-old man presented with sudden-onset abdominal pain. Computed tomography showed a hematoma in the gastric wall. The patient was discharged after the pain was relieved but returned 8 h later with abdominal pain and shock. Repeated computed tomography revealed a massive intra-abdominal hemorrhage without previous aneurysm formation. Emergency angiography and coil embolization were successfully carried out. Segmental arterial mediolysis was diagnosed after irregular vasodilated lesions were observed in multiple arteries.
This case suggests that accurately predicting the next vessel rupture is difficult. For patients experiencing intra-abdominal bleeding with segmental arterial mediolysis, we suggest treating only ruptured aneurysms and closely following-up unruptured aneurysms.
我们描述了一例节段性动脉中层溶解病例，该病例中血管在连续两天内破裂。
一名69岁男性突发腹痛。计算机断层扫描显示胃壁有血肿。疼痛缓解后患者出院，但8小时后因腹痛和休克再次入院。重复计算机断层扫描显示腹腔内大量出血，之前无动脉瘤形成。成功进行了急诊血管造影和弹簧圈栓塞。在多条动脉中观察到不规则的血管扩张性病变后，诊断为节段性动脉中层溶解。
该病例表明准确预测下一次血管破裂很困难。对于患有节段性动脉中层溶解并出现腹腔内出血的患者，我们建议仅治疗破裂的动脉瘤，并密切随访未破裂的动脉瘤。
