Abstract
A 77-year-old woman admitted to our hospital due to nausea and vomiting. Enlargement of the gallbladder was detected by abdominal CT scan and she was diagnosed with acute cholecystitis. As she had poorly controlled diabetes mellitus, PTGBD (percutaneous transhepatic gallbladder drainage) was carried out to improve inflammation. Ten days after admission, her transient abdominal pain and pre-shock status were successfully treated by fluid supplementation. Seven days after the initial episode, rapidly progressive anemia (Hb, 8.1g/dL to 5.4g/dL) was indicated. Immediate dynamic CT scan revealed ruptured aneurysm of the left gastroepiploic artery that was not detected by the initial CT scan. Urgent laparotomy was carried out and the partial omentectomy, including the aneurysm, and also underwent splenectomy and cholecystectomy.
Previous case reports of splanchnic artery aneurysm have indicated several pathogeneses for aneurysmal formation, such as segmental arterial mediolysis. However, pathological evaluation of our case demonstrated a ruptured pseudoaneurysm without specific pathogenesis. Further investigation is required to elucidate the mechanism of aneurysm formation.
