Rupture of an Aneurysm of the Middle Colic Artery

A 67-year-old woman came to our emergency department due to epigastralgia over the course of the previous 24 h along with symptoms of syncope and hypotension, which improved after fluid resuscitation. Abdominal ultrasound and CT scan showed important hemoperitoneum, hematoma in the region of the head of the pancreas (Figs. 1 and 2; hematoma [*] and aneurysm [arrow]) and an aneurysm of the middle colic artery (Figs. 3 and 4; superior mesenteric artery [A], middle colic artery [B] and aneurysm of the middle colic artery [C]). The patient was hemodynamically unstable, so we decided to perform urgent exploratory laparotomy. The procedure revealed massive hemoperitoneum and a fusiform aneurysm of the middle colic artery, with rupture at the cranial end that was actively bleeding. This was ligated, and the colon recovered a healthy appearance. The patient presented an uneventful recovery.

Fig. 1

Fig. 2

Fig. 3

Fig. 4