A case of the intraabdominal hemorrhage due to Segmental Aaterial mediolysis(SAM)

症例は65歳の女性で,下腹部痛を主訴に受診し,腹部CTで内臓動脈瘤破裂による腹腔内出血と診断された.血管造影検査では広範囲にわたって血管径の不整や動脈瘤が認められ,回結腸動脈瘤が出血源と考えられた.動脈塞栓術にて症状は改善した.血管造影所見から分節性動脈中膜融解,segmental arterial mediolysis(以下,SAM)と診断された.TAE後1年10ヵ月のCTでは,未治療の動脈瘤と血管狭窄は消失していた.SAMは比較的稀な疾患であり,長期予後の報告もないため自然予後を理解する上で興味ある症例と思われたので,報告する.

A 65-year-old woman admitted for lower abdominal pain and hypotension. A ruptured abdominal visceral aneurysm with intraabdominal hemorrhage was shown on abdominal computed tomography（CT）． Wide-ranging irregularity in vascular diameter and aneurysm was shown on angiography, suggesting a rupture of an aneurysm of the cecal-colic artery. Hemostasis was achieved by transcatheter arterial embolization（TAE）with microcoils. These findings are attributed to segmental arterial mediolysis（SAM）in this case. The multiple untreated aneurysm and narrowing had almost disappeared on CT 1 year and 10 after the TAE. The natural history of a relatively rare SAM treated by TAE was interesting and valuable in this case.

分節性動脈中膜融解

segmental arterial mediolysis（SAM）

腹腔内出血

腹部内臓動脈瘤