|Year : 2020 | Volume
| Issue : 1 | Page : 96-98
Jet flow aneurysm of inferior mesenteric artery
Sam Pon Raj1, Edwin Stephen2, Albert Kota2, Vimalin Samuel2, Dheepak Selvaraj2, Prabhu Premkumar2, Sunil Agarwal2
1 Department of Vascular Surgery, CSI Mission Hospital, Tiruchirapalli, Tamil Nadu, India
2 Department of Vascular Surgery, Christian Medical College, Vellore, Tamil Nadu, India
|Date of Submission||19-Feb-2019|
|Date of Decision||01-Mar-2019|
|Date of Acceptance||15-Mar-2019|
|Date of Web Publication||16-Mar-2020|
Dr. Sam Pon Raj
Department of Vascular Surgery, CSI Mission Hospital, Tiruchirapalli, Tamil Nadu
Source of Support: None, Conflict of Interest: None
A 56-year-old male was evaluated for postprandial abdominal pain and was detected to have an inferior mesenteric artery (IMA) aneurysm associated with critical ostial stenosis of the celiac and superior mesenteric arteries. He underwent aneurysmorrhaphy of the IMA along with revascularization of the superior mesenteric artery with graft from the aorta using a 6-mm ringed polytetrafluoroethylene graft and made an uneventful recovery.
Keywords: Aneurysm, inferior mesenteric artery, jet flow, surgical repair
|How to cite this article:|
Raj SP, Stephen E, Kota A, Samuel V, Selvaraj D, Premkumar P, Agarwal S. Jet flow aneurysm of inferior mesenteric artery. Indian J Vasc Endovasc Surg 2020;7:96-8
|How to cite this URL:|
Raj SP, Stephen E, Kota A, Samuel V, Selvaraj D, Premkumar P, Agarwal S. Jet flow aneurysm of inferior mesenteric artery. Indian J Vasc Endovasc Surg [serial online] 2020 [cited 2020 Apr 8];7:96-8. Available from: http://www.indjvascsurg.org/text.asp?2020/7/1/96/280659
| Introduction|| |
Aneurysm of the inferior mesenteric artery (IMA) is the least common of all visceral artery aneurysms. We present a case of an inferior mesenteric aneurysm associated with narrowing or occlusion of the other mesenteric vessels.
| Case Report|| |
A 56-year-old male, a diagnosed case of myeloproliferative disorder on treatment underwent ultrasound examination of the abdomen for the evaluation of postprandial abdominal pain with no associated weight loss. He was also a diagnosed case of portal hypertension secondary to portal vein thrombosis but did not have any history of upper gastrointestinal bleed or ascites. Physical examination of the abdomen was unremarkable. An ultrasound examination done revealed a 4 cm × 4.5 cm aneurysm arising from the inferior mesenteric artery. A computed tomography angiogram done for further characterization of the aneurysm revealed a fusiform aneurysm of the proximal IMA and critical ostial stenosis of the superior mesenteric artery (SMA) and the celiac trunk with a normal IMA ostium [Figure 1], [Figure 2], [Figure 3], [Figure 4]. Vasculitic markers, blood culture to exclude mycotic aneurysm were done to rule out other etiologies of visceral artery aneurysms. The patient underwent aorto SMA bypass with a 6-mm ringed polytetrafluoroethylene (PTFE) graft and IMA aneurysmorraphy with a 6-mm ringed PTFE [Figure 2]. The biopsy from the aneurysm wall was suggestive of atherosclerotic aneurysm. He had an uneventful postoperative period.
Bypass with PTFE and IMA aneurysmorrhaphy with PTFE graft [Figure 5] and [Figure 6].
|Figure 6: Intraoperative picture showing aorto superior mesenteric artery|
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| Discussion|| |
Visceral artery aneurysms are uncommon aneurysms and are increasingly being diagnosed with incidental findings due to improved diagnostic modalities. Visceral artery aneurysm presenting as an emergency with rupture is more common compared to similar pathology in other blood vessels. Distribution of aneurysms within the visceral circulation are splenic (60%), hepatic (20%), superior mesenteric (5.5%), celiac (4%), gastric and epiploic (4%), pancreatic (2%), pancreaticoduodenal (1.5%), and gastroduodenal arteries (1.5%).,
IMA aneurysm is the least common presentation of visceral artery aneurysm. The common causes for the aneurysmal dilatation of IMA are atherosclerotic, mycotic, and various types of large and medium vessel vasculitis. The association of IMA aneurysm with occlusive disease of the other mesenteric vessels is uncommon association in the literature. The etiology of the aneurysm is suspected to due to the high flow in the thin-walled IMA due to occlusive disease in the other two vessels; this is named the “jet-flow phenomenon.”, Repair of these is indicated since the mesenteric vessels are thin walled and rupture is associated with high mortality. Revascularization of the other mesenteric vessels along with repair of the aneurysm is the standard of care. Case reports of the endovascular intervention of the occluded mesenteric vessels followed by open repair of aneurysm are available; although, open mesenteric revascularization along with open repair of the aneurysm has been commonly practiced.
| Conclusion|| |
IMA aneurysm with occlusive disease of the superior mesenteric artery and celiac artery is found infrequently. Surgical management of the aneurysm with along with revascularization of the diseased mesenteric vessels would be beneficial.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]