Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2024 Mar:116:109418.
doi: 10.1016/j.ijscr.2024.109418. Epub 2024 Feb 20.

A case of rectal cancer complicated with segmental arterial mediolysis (SAM) safely treated with curative resection - A case report

Tamuro Hayama  1 , Hiroki Ochiai  2 , Keijiro Nozawa  2 , Yoshinao Kikuchi  3 , Yuko Sasajima  3 , Takeo Fukagawa  2
Affiliations
Case Reports

A case of rectal cancer complicated with segmental arterial mediolysis (SAM) safely treated with curative resection - A case report

Tamuro Hayama et al. Int J Surg Case Rep. 2024 Mar.

Abstract

Introduction: Recent advances in diagnostic imaging techniques have led to an increasing number of case reports of segmental arterial mediolysis (SAM). However, reports of abnormalities associated with SAM of abdominal organs, including the bowel, are limited. SAM, a rare vascular disease that causes spontaneous intra-abdominal bleeding, including shock and intestinal ischemia, has been reported to be associated with high mortality, but it has not been reported to coexist with rectal cancer.

Case presentation: A 74 year-old male was referred to our hospital with a rectal cancer and he was admitted for further examination. Computed tomography angiography (CTA) revealed dissection and aneurysm in the celiac artery, superior mesenteric artery (SMA), and the inferior mesenteric artery were dilated, leading to a diagnosis of SAM.

Clinical discussion: Surgery for rectal cancer requires cutting the inferior mesenteric artery. The risk of bleeding during surgery increases when SAM is associated with the inferior mesenteric artery. The radical surgery for rectal cancer was executed without complications, including significant bleeding. This was achieved through careful management of SAM, meticulous control of blood pressure throughout the surgical procedure, and the delicate treatment of the SMA. A pathological diagnosis of the resected inferior mesenteric artery at the time of radical surgery was performed, and a definitive diagnosis of SAM was made.

Conclusion: We present a first known case in which high anterior resection was successfully performed for rectal cancer complicated by SAM. The relationship between cancer and SAM is unclear and further case accumulation is needed.

Keywords: Case report; Colorectal cancer; Segmental arterial mediolysis; Surgery.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest statement The authors declare no conflicts of interest associated with this manuscript.

Figures

Fig. 1
Fig. 1
Abdominal computed tomography angiography scan. a: CTA of the abdomen: Pseudoaneurysm of superior mesenteric artery observed by three-dimensional computed tomography angiography (arrow). b: CTA of the abdomen shows pseudoaneurysm (arrow) of the celiac artery.
Fig. 2
Fig. 2
Virtual enema image and Abdominal computed tomography angiography scan. The green part represents the tumor, and the inferior mesenteric artery expands from the middle and an aneurysm is recognized (arrow). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
Fig. 3
Fig. 3
A. Disruption of the smooth muscle in the media (arrowheads) with associated mucoid intimal changes. (H&E, 400×). B. Mucous staining reveals mucosal degeneration in the intima (*) and between the media and adventitia (arrowhead) (alcian blue staining, 400×). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
Fig. 4
Fig. 4
Pathological specimen. A type 2 lesion is found in the center of the specimen.
See this image and copyright information in PMC

References

    1. Slavin R.E., Gonzalez-Vitale J.C. Segmental mediolytic arteritis: a clinical pathologic study. Lab. Investig. 1976;35(1):23–29. - PubMed
    1. Slavin R.E., Saeki K., Bhagavan B., Maas A.E. Segmental arterial mediolysis: a precursor to fibromuscular dysplasia? Mod. Pathol. 1995;8(3):287–294. - PubMed
    1. Slavin R.E. Segmental arterial mediolysis: course, sequelae, prognosis, and pathologic-radiologic correlation. Cardiovasc. Pathol. 2009;18(6):352–360. - PubMed
    1. Shimohira M., Kondo H., Ogawa Y., Kawada H., Koganemaru M., Ikeda O., et al. Natural history of unruptured visceral artery aneurysms due to segmental arterial mediolysis and efficacy of transcatheter arterial embolization: a retrospective multiinstitutional study in Japan. AJR Am. J. Roentgenol. 2021;216(3):691–697. - PubMed
    1. Sohrabi C., Mathew G., Maria N., Kerwan A., Franchi T., Agha R.A. The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines. Int. J. Surg. 2023;109(5):1136–1140. - PMC - PubMed

Publication types