Mini-Laparotomy for Superior Mesenteric Artery Aneurysm Due to Takayasu's Arteritis

Abstract

Superior mesenteric artery aneurysm (SMAA) is reported to be the third-most common type of visceral aneurysm (VA), accounting for 5% of all VAs. The etiology of SMAA is commonly thought to be infection, and it usually exists in the proximal part of the superior mesenteric artery, which is suitable for endovascular treatment. We herein report an extremely rare case of the distal part of SMAA caused by Takayasu's arteritis (TA), which was successfully resected using a mini-laparotomy method without impairing the intestinal blood supply. A 51-year-old woman was admitted to our hospital with sustained fever and lower back pain. Physical examination showed that she had a discrepancies in blood pressure between both arms. Contrast-enhanced wholebody computed tomography showed stenosis of the thoracic aorta and an aneurysm located in the distal part of the superior mesenteric artery. The diameter of the aneurysm was 4.5 cm. The aneurysm was resected via 4-cm mini-laparotomy, and the vascularity of the intestine was successfully preserved. The postoperative course was uneventful, and the patient was diagnosed as having TA based on both clinical and pathologic findings. Additional corticosteroid therapy was started to treat the arteritis, and at 3-month followup she was without critical incidents. Mini-laparotomy is a safe and less-invasive approach to treat SMAA, especially when the lesion is located in the distal part of the artery.

Successful conservative treatment of an isolated inflammatory superior mesenteric artery aneurysm

“…First, our patient had abdominal pain, which is the most common symptom in patients with inflammatory aneurysms [ 10 ]. Second, the inflammatory markers were elevated, which was consistent with inflammatory aneurysms [ 3 , 4 ]. Third, CT showed a saccular aneurysm with arterial wall thickening.…”

“…Histopathologic examination remains the gold standard in the diagnosis of inflammatory SMA aneurysms [ 3 , 4 ]. It was not performed because of conservative treatment in this case.…”

“…For ruptured inflammatory SMA aneurysms, emergency surgery is usually required regardless of disease activity [ 4 ]. However, there is no consensus on operation timing for unruptured aneurysms.…”

Presentation and management of rare saccular superior mesenteric artery trunk and branch aneurysms

“… 12 Traumatic SMAA has also been reported. 13 Less common etiologies include Behcet's disease, 14 Takayasu's arteritis, 15 segmental arterial mediolysis, 16 , 17 Ehlers-Danlos syndrome, 18 and fibromuscular dysplasia. 19 Just as in adults, the pediatric population can also be affected by mycotic aneurysms, although rarely reported.…”

Esophageal Artery Pseudoaneurysm and Takayasu Arteritis in a Patient with Autosomal Dominant Polycystic Kidney Disease

“…Both ADPKD and Takayasu arteritis can cause vascular complications, but involvement of the visceral arteries is uncommon 4 7) . There have been no reports of the simultaneous diagnosis of ADPKD and Takayasu arteritis, and this is also the first reported case of esophageal artery pseudoaneurysm in a patient with both ADPKD and Takayasu arteritis.…”