Ruptured Middle Colic Artery Aneurysm Presenting with Symptoms of Acute Cholecystitis: A Case Report and Literature Review

Abstract

Garrett GRJ Johnson,1,2 Surinder Dhaliwal,3 Sebastian Launcelott,4 Eric Hyun,1 Ramzi Helewa,1 Farhana Shariff,1 David Hochman1 1Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; 2Clinician Investigator Program, University of Manitoba, Winnipeg, Manitoba, Canada; 3Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada; 4Department of Surgery, Section of Vascular Surgery, University of Manitoba, Winnipeg, Manitoba, CanadaCorrespondence: David Hochman, Department of Surgery, Section of General Surgery, University of Manitoba, 343 Tache Avenue, Winnipeg, Manitoba, R2H 2A5, Canada, Tel [phone], Fax [phone], Email [email protected]: Ruptured middle colic artery aneurysm is extremely uncommon. Diagnosis can be challenging, as symptomatology can be attributed to more common abdominal pathologies. Due to the rarity of this condition, only case reports are available to inform management.Case Presentation: We present the case of a 72-year-old woman with a ruptured middle colic artery aneurysm presenting with signs and symptoms more suggestive of acute calculous cholecystitis. Her co-existing bleed was confirmed on CT angiogram. Coil embolization was initially attempted unsuccessfully. She underwent laparotomy, a middle colic artery ligation, and extended right hemicolectomy with intra-aortic balloon placement for emergency proximal vascular control. Post-operatively, she had a re-bleed that was successfully managed with covered stent placement in the proximal superior mesenteric artery after an unsuccessful re-attempt at coil embolization. Her apparent associated cholecystitis was managed with antibiotics and resolved uneventfully.Conclusion: A middle colic artery aneurysm can be challenging to diagnose and treat. Management options include endovascular techniques, open surgery, or a combination approach. Intra-aortic balloon placement for emergency vascular control is a novel approach that could avoid hemorrhage when intra-abdominal vascular access is challenging.Keywords: middle colic artery, mesenteric aneurysm, endovascular therapy, coil embolization, intra-aortic balloon placement

Keywords

• middle colic artery
• mesenteric aneurysm
• endovascular therapy
• coil embolization
• intra-aortic balloon placement