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Updated: Apr 14, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Mini-Laparotomy for Superior Mesenteric Artery Aneurysm Due to Takayasu's Arteritis
Takatsugu Matsumoto1, Mitsuru Ishizuka, Yukihiro Iso
1Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
Abstract:
Superior mesenteric artery aneurysm (SMAA) is reported to be the third-most common type of visceral aneurysm (VA), accounting for 5% of all VAs. The etiology of SMAA is commonly thought to be infection, and it usually exists in the proximal part of the superior mesenteric artery, which is suitable for endovascular treatment. We herein report an extremely rare case of the distal part of SMAA caused by Takayasu's arteritis (TA), which was successfully resected using a mini-laparotomy method without impairing the intestinal blood supply. A 51-year-old woman was admitted to our hospital with sustained fever and lower back pain. Physical examination showed that she had a discrepancies in blood pressure between both arms. Contrast-enhanced whole-body computed tomography showed stenosis of the thoracic aorta and an aneurysm located in the distal part of the superior mesenteric artery. The diameter of the aneurysm was 4.5 cm. The aneurysm was resected via 4-cm mini-laparotomy, and the vascularity of the intestine was successfully preserved. The postoperative course was uneventful, and the patient was diagnosed as having TA based on both clinical and pathologic findings. Additional corticosteroid therapy was started to treat the arteritis, and at 3-month follow-up she was without critical incidents. Mini-laparotomy is a safe and less-invasive approach to treat SMAA, especially when the lesion is located in the distal part of the artery.
Insights
This study reports a rare distal superior mesenteric artery aneurysm (SMAA) caused by Takayasu's arteritis (TA). A successful mini-laparotomy resection preserved intestinal blood supply, demonstrating a minimally invasive treatment option.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Rheumatology
Background:
- Superior mesenteric artery aneurysm (SMAA) is the third most common visceral aneurysm (VA), typically caused by infection and located proximally.
- Proximal SMAAs are often amenable to endovascular treatment, but distal SMAAs present unique challenges.
Observation:
- A 51-year-old woman presented with fever and back pain, exhibiting blood pressure discrepancies between arms.
- CT revealed thoracic aorta stenosis and a 4.5 cm distal SMAA, indicative of Takayasu's arteritis (TA).
Findings:
- The distal SMAA was successfully resected using a 4-cm mini-laparotomy, preserving intestinal vascularity.
- Pathologic and clinical findings confirmed TA as the etiology.
- Postoperative corticosteroid therapy was initiated for the arteritis.
Implications:
- Mini-laparotomy is a safe and effective minimally invasive approach for treating distal SMAAs, even those associated with inflammatory conditions like TA.
- This case highlights the importance of considering rare etiologies and anatomical locations for SMAA management.
