A Case of Segmental Arterial Mediolysis Presenting as Mucosal Gastric Hematoma
Background. 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 int...
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Wiley
2017-01-01
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| Series: | Case Reports in Gastrointestinal Medicine |
| Online Access: | http://dx.doi.org/10.1155/2017/3634967 |
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| author | Shunsuke Sakuraba Hajime Orita Shuhei Ueda Satoshi Tokuda Tomoaki Ito Tomoyuki Kushida Mutsumi Sakurada Hiroshi Maekawa Ryo Wada Koichi Sato |
| author_facet | Shunsuke Sakuraba Hajime Orita Shuhei Ueda Satoshi Tokuda Tomoaki Ito Tomoyuki Kushida Mutsumi Sakurada Hiroshi Maekawa Ryo Wada Koichi Sato |
| author_sort | Shunsuke Sakuraba |
| collection | DOAJ |
| description | Background. 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. Case Presentation. 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. Conclusion. 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. |
| format | Article |
| id | doaj-art-1cbf18b67ba840d2a33d818968bcc4df |
| institution | Kabale University |
| issn | 2090-6528 2090-6536 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Gastrointestinal Medicine |
| spelling | doaj-art-1cbf18b67ba840d2a33d818968bcc4df2025-02-03T01:09:31ZengWileyCase Reports in Gastrointestinal Medicine2090-65282090-65362017-01-01201710.1155/2017/36349673634967A Case of Segmental Arterial Mediolysis Presenting as Mucosal Gastric HematomaShunsuke Sakuraba0Hajime Orita1Shuhei Ueda2Satoshi Tokuda3Tomoaki Ito4Tomoyuki Kushida5Mutsumi Sakurada6Hiroshi Maekawa7Ryo Wada8Koichi Sato9Department of Surgery, Juntendo Shizuoka Hospital, Shizuoka, JapanDepartment of Surgery, Juntendo Shizuoka Hospital, Shizuoka, JapanDepartment of Surgery, Juntendo Shizuoka Hospital, Shizuoka, JapanDepartment of Surgery, Juntendo Shizuoka Hospital, Shizuoka, JapanDepartment of Surgery, Juntendo Shizuoka Hospital, Shizuoka, JapanDepartment of Surgery, Juntendo Shizuoka Hospital, Shizuoka, JapanDepartment of Surgery, Juntendo Shizuoka Hospital, Shizuoka, JapanDepartment of Surgery, Juntendo Shizuoka Hospital, Shizuoka, JapanDepartment of Pathology, Juntendo Shizuoka Hospital, Shizuoka, JapanDepartment of Surgery, Juntendo Shizuoka Hospital, Shizuoka, JapanBackground. 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. Case Presentation. 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. Conclusion. 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.http://dx.doi.org/10.1155/2017/3634967 |
| spellingShingle | Shunsuke Sakuraba Hajime Orita Shuhei Ueda Satoshi Tokuda Tomoaki Ito Tomoyuki Kushida Mutsumi Sakurada Hiroshi Maekawa Ryo Wada Koichi Sato A Case of Segmental Arterial Mediolysis Presenting as Mucosal Gastric Hematoma Case Reports in Gastrointestinal Medicine |
| title | A Case of Segmental Arterial Mediolysis Presenting as Mucosal Gastric Hematoma |
| title_full | A Case of Segmental Arterial Mediolysis Presenting as Mucosal Gastric Hematoma |
| title_fullStr | A Case of Segmental Arterial Mediolysis Presenting as Mucosal Gastric Hematoma |
| title_full_unstemmed | A Case of Segmental Arterial Mediolysis Presenting as Mucosal Gastric Hematoma |
| title_short | A Case of Segmental Arterial Mediolysis Presenting as Mucosal Gastric Hematoma |
| title_sort | case of segmental arterial mediolysis presenting as mucosal gastric hematoma |
| url | http://dx.doi.org/10.1155/2017/3634967 |
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