Case of fibromuscular dysplasia with multiple aneurysms in a young woman

We report a case of fibromuscular dysplasia (FMD). The patient was a 22-year-old female who had received treatment for hypertension for two years. She had also presented with hemorrhage caused by an annular ulcer in the small intestine. In March 2012, she had abdominal pain, was diagnosed with rupture of aneurysms of the gastroepiploic artery, and received embolization. In July 2012, she felt abdominal pain, presented with ruptured aneurysms of the left hepatic artery. She had abdominal pain again and suffered hemorrhagic shock. Contrast-enhanced computed tomography scanning of her abdomen revealed rupture of the left hepatic artery aneurysms and she received emergent coil embolization. Aneurysm expansion was noted, which suggested the necessity of early diagnosis and treatment, but the diagnosis was difficult because a few systemic findings were observed without any typical angiography findings. We decided to perform a small bowel resection for the complication of annular ulcers and reached a diagnosis of FMD according to pathological findings. Differential diagnosis between inflammatory and noninflammatory arteriopathy is difficult in many cases and often largely affects treatment policies. We experienced a rare case where we reached a definite diagnosis of FMD based on pathology of the small intestine ulcer. <Learning objective: Fibromuscular dysplasia is a type of noninflammatory arteriopathy, but the clinical condition is still unknown. The differentiation between inflammatory and noninflammatory arteriopathy is highly difficult in many cases and largely different treatment policies are applied to these two types of arteriopathy. Rapid decision making regarding the use of immunosuppressant drugs is necessary. We reached a definite diagnosis based on pathological findings of annular ulcers of the small intestine.>.