Mesenteric artery aneurysms are rare and represent 0.1% of all arterial aneurysms. This case is about a 66-year-old female patient with no significant pathological history consulting the emergency department for sudden brutal epigastric pain. An abdominal CT angiography was done showing an image in favor of a hematoma related to an aneurysm.
Mesenteric artery aneurysms are rare and represent 0.1%
of all arterial aneurysms. The superior mesenteric artery is the
predilected site for these aneurysms and is associated with an
increased risk of rupture. Several etiologies can be in cause but the
main cause remain the infectious state especially in young adults.
In older patients, it is mainly atherosclerosis and fibro-dysplastic
diseases.
This case is about a 66-year-old female patient with no
significant pathological history consulting the emergency
department for sudden brutal epigastric pain. An abdominal CT
angiography was done showing an image in favor of a hematoma
measuring 121* 69 mm in diameter located at the right parietocolic
region, encompassing a hypovascularized image of 15 mm
in diameter, at the expense of a branch of the superior mesenteric
artery related to an aneurysm. She was also hemodynamically
stable. On intraoperative exploration, we found a non-beating
thrombosed false aneurysm compacting the right colonic angle
(Figure1). The exploration of AMS at the level of the root of the
mesentery finds a well beating AMS. Our surgical approach was
a flattening of the aneurysm with evacuation of the hematoma
(Figures 2 and 3). The vascular breach was found and sutured. The
postoperative was simple and the patient was discharged after four
days of the surgery.
Figure 1: A false aneurysm of a branch of the AMS aneurysm.
Figure 2: Thrombosis of the false.
Figure 3: The false aneurysm after its flattening.
Superior mesenteric artery aneurysm is rare. It seems to affect
men and women equally. It is more common in people over 50 years
old. Unlike aneurysms reaching the other arteries whose primum
movens is atherosclerosis, the aneurysm of the SMA is due in 60%
of cases to an infectious cause. Hematogenous dissemination from
a septic focus seems to be the most frequent way of contamination.
In rare cases, the SMA aneurysm can be a way of revealing
systemic vasculitis. The clinical presentation is associated with
an atroce and brutal abdominal pain. It can be associated with
post prandial pain simulating a mesenteric ischemia. The clinical
presentation can sometimes be less brutal and more misleading
combining nausea, vomiting and fever. CT angiography seems to
be the most appropriate complementary exam, showing the exact location of the aneurysm, its size, and whether there is a rupture. The treatment can be either an open surgery or an endovascular
approach. However, open surgery remains the gold standard. It can
be either the simple flattening and exclusion of the aneurysm or a
flattening associated with a revascularization gesture.
Though, it is increasingly recommended to try the endovascular
alternative as first intention, when the anatomy is favorable, either
by embolization or by using covered stents. The major drawback of
this route is the risk of collateral hedging.
Mesenteric artery aneurysm is a rare entity. The diagnosis is
often overlooked because of a misleading clinical presentation.
The etiology is dominated by infectious pathologies. Open surgery
remains the gold standard, but the endovascular approach is
increasingly considered.