Published online Jul 28, 2013. doi: 10.3748/wjg.v19.i28.4630
Revised: May 20, 2013
Accepted: June 1, 2013
Published online: July 28, 2013
This case report describes an unusual case of upper gastrointestinal (UGI) bleeding caused by a ruptured superior mesenteric artery (SMA) aneurysm in the duodenum in a patient with rheumatoid arthritis. The patient presented with UGI bleeding and hemorrhagic shock. Emergency UGI endoscopy could not identify the source of the bleeding because of excessive blood clots under the second portion of the duodenum. An SMA aneurysm with active contrast extravasation was diagnosed by computed tomography. The aneurysm, together with the fourth portion of the duodenum and the proximal portion of the jejunum, was surgically resected, and the SMA was skeletonized. On postoperative day 15, the patient was discharged from hospital under satisfactory conditions. Rheumatoid arthritis has been known to cause a wide spectrum of manifestations, and an SMA aneurysm is an unusual extra-articular manifestation. An SMA aneurysm rupture presenting as upper gastrointestinal bleeding is a rare complication with a high mortality rate. The clinician must be alert to this potential issue to achieve rapid diagnostic confirmation, and immediate surgical or radiological intervention.
Core tip: Gastrointestinal bleeding is a common medical emergency. Ruptured superior mesenteric artery aneurysm is an uncommon cause of gastrointestinal bleeding, with few cases reported previously. Diagnosis is difficult before surgery. We reported the successful diagnosis and treatment of such a case.