Biphasic clinical course of a ruptured right gastric artery aneurysm caused by segmental arterial mediolysis: a case report

Abstract

Background: 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. Case presentation: 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 contrastenhanced 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. Conclusions: An RGA aneurysm rupture should be considered a differential diagnosis in patients presenting with hemoperitoneum with a slow or biphasic clinical course.

Presentation of unruptured right gastric aneurysm due to segmental arterial mediolysis resected laparoscopically: A case report

“…Case reports of right gastric artery aneurysms are exceedingly rare, and to our knowledge, only nine cases have been reported in the literature to date. All of these cases presented due to rupture, and there have been no reports of resection before rupture [ 8 , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] ]. We summarized the 10 cases of right gastric artery aneurysms, including the present case, in Table 1 .…”

Point‐of‐care ultrasound‐assisted diagnosis of gastric vessel rupture in a young man presenting with chest pain: A cautionary tale

“…5,6 It mostly occurs due to rupture of aneurysmal disease, which can be predisposed by vasculitis, hypertension, dyslipidaemia or tumour. 7,8 There have also been a few cases reported as a result of medical procedures, such as endoscopy. 9 In prior case reports, patients with rupture of the gastric vessels typically present with abdominal pain after vomiting or gagging and haemodynamic instability, which were absent in this case.…”

“…Spontaneous intraperitoneal haemorrhage is rare with its true incidence unknown 5,6 . It mostly occurs due to rupture of aneurysmal disease, which can be predisposed by vasculitis, hypertension, dyslipidaemia or tumour 7,8 . There have also been a few cases reported as a result of medical procedures, such as endoscopy 9…”

Spontaneous rupture of the umbilical vein associated with liver cirrhosis: A case report

“…IVR is useful for arterial hemorrhages from the series of intra-abdominal arteries: the celiac artery, superior mesenteric artery, and inferior mesenteric artery. In several case reports, transarterial embolization successfully controlled hemoperitoneum caused by rupture of aneurysms in the intra-abdominal arteries [5] , [6] , [17] , [18] . Arterial portography is not sufficient for detecting portal hemorrhage.…”