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Superior Mesenteric Artery Aneurysm Rupture: A Case Report
OBJECTIVES:
Although visceral artery aneurysms are mainly asymptomatic, more than 90% of SMA aneurysms are symptomatic⁷. Intermittent abdominal pain is the most common clinical presentation. Other symptoms include a palpable mass, fever, nausea, gastrointestinal bleeding, jaundice, anemia, and shock⁸. The main risk associated with SMAAs is rupture, which has a high rate of mortality. We present a case of a male with abdominal pain who was found to have a superior mesenteric artery aneurysm rupture.
Methods: An 88 year old male presented to the emergency department with syncope and abdominal pain that started several hours prior to admission to a local hospital. An abdominopelvic CT scan revealed a ruptured superior mesenteric artery aneurysm with hemoperitoneum. The patient was transferred to our facility hemodynamically unstable.
Results: A cutdown of the left common femoral artery was performed. Using endovascular access techniques, an aortogram was performed and an occlusive balloon was then inflated to obtain proximal control. Subsequent laparotomy revealed two liters of blood. A large hematoma was noted in the mesentery. Upon evacuation, a 0.5-cm hole was noted. The aneurysm was resected and primary anastomosis performed. The patient tolerated the procedure well without complication.
Conclusion: A superior mesenteric artery aneurysm is a rare, but serious life-threatening condition. All patients should be highly considered for interventional procedures. Treatment options are available for patients at good operative risk (open surgical repair), and patients with comorbidities (endovascular techniques). In the case of our patient, emergent surgical intervention involving both endovascular occlusive balloon and laparotomy was required for repair of a SMAA rupture.