Acute abdominal pain: a challenging diagnosis

Area of Science:

• Vascular Surgery
• Gastroenterology
• Radiology

Background:

• Segmental Arteriolar Mediolysis (SAM) is a rare, non-atherosclerotic vascular disease affecting medium-sized arteries.
• It typically presents with abdominal pain, often mimicking other acute abdominal conditions.
• Differential diagnoses include vasculitis, fibromuscular dysplasia, and other causes of arterial dissection or infarction.

Observation:

• A 41-year-old male with no prior medical history presented with acute abdomen.
• Abdominal CT revealed coeliac trunk dissection and splenic infarction.
• Initial treatment with high-dose IV steroids was initiated for presumed vasculitis.

Findings:

• Further investigations led to the diagnosis of Segmental Arteriolar Mediolysis (SAM).
• This case highlights the importance of considering SAM in the differential diagnosis of acute abdominal presentations with arterial abnormalities.
• The patient's presentation, diagnostic pathway, and treatment are detailed.

Implications:

• Accurate and timely diagnosis of SAM is essential for appropriate management and to avoid unnecessary treatments like high-dose steroids for incorrect diagnoses.
• This case report contributes to the understanding of SAM's clinical presentation and diagnostic criteria.
• Provides valuable insights for clinicians managing patients with unexplained arterial dissections and infarctions.