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Case Reports in Gastrointestinal Medicine
Volume 2017 (2017), Article ID 3634967, 4 pages
https://doi.org/10.1155/2017/3634967
Case Report

A Case of Segmental Arterial Mediolysis Presenting as Mucosal Gastric Hematoma

1Department of Surgery, Juntendo Shizuoka Hospital, Shizuoka, Japan
2Department of Pathology, Juntendo Shizuoka Hospital, Shizuoka, Japan

Correspondence should be addressed to Shunsuke Sakuraba; moc.liamg@ekusnuhs8nulnul and Hajime Orita; pj.ca.odnetnuj@iroiro

Received 11 June 2017; Revised 20 August 2017; Accepted 16 October 2017; Published 23 November 2017

Academic Editor: Yoshihiro Moriwaki

Copyright © 2017 Shunsuke Sakuraba et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Although segmental arterial mediolysis (SAM) has been increasingly recognized as arteriopathy and there are some case reports about SAM, it is still very rare. It is characterized clinically by aneurysm, dissection, stenosis, and occlusion within splanchnic arterial branches, causing intra-abdominal hemorrhage or bowel ischemia. Mortality is as high as 50% in acute events. Case Presentation. A 51-year-old man was referred to our hospital with hematemesis. Gastroscopy revealed a submucosal-like tumor on the posterior wall of gastric angle with ulceration. Computed tomography indicated a tumor measuring  mm in the stomach, which was suspected to have invaded into the pancreas. Significant hematemesis recurred; the patient developed shock and underwent emergency distal gastrectomy, distal pancreatectomy, and splenectomy. The pathology and the clinical course were compatible with SAM splenic artery rupture causing retroperitoneal hemorrhage that penetrated into the stomach. After that surgery, aneurysm of common hepatic artery ruptured and coil embolization was performed. Conclusion. SAM is an important cause of intra-abdominal or retroperitoneal hemorrhage in patients without underlying disease. SAM typically presents as intra-abdominal hemorrhage, but, in this case, the retroperitoneal hemorrhage penetrated into the stomach and it looked like a submucosal tumor.