title: Idiopathic spontaneous haemoperitoneum due to a ruptured middle colic artery aneurysm.
abstract: BACKGROUND
  Idiopathic spontaneous intra-abdominal haemorrhage is a rare, but challenging condition, associated with high mortality if not managed appropriately. The preoperative diagnosis is difficult, despite the recent advances in imaging. We present the clinical manifestations of this condition, as well as the available diagnostic and therapeutic modalities.
  
  
  METHODS
  We report a case of a spontaneously ruptured dissecting aneurysm of the middle colic artery, which was managed with an emergency laparotomy and aneurysmatectomy. Interestingly, no evidence of vasculitis, infection or collagen disease was discovered during the histopathology examination of the specimen.
  
  
  CONCLUSIONS
  The treatment of idiopathic spontaneous intra-abdominal haemorrhage revolves around patient resuscitation and management of the source of bleeding. In case of a ruptured aneurysm of the middle colic artery, the surgical management includes emergency laparotomy, arterial ligation and resection of the aneurysm. Transarterial embolisation has been suggested as a safe and less invasive alternative approach.
  
  
  CONCLUSIONS
  A ruptured middle colic artery aneurysm should be included in the differential diagnosis of any unexplained intra-abdominal haemorrhage. Aneurysmatectomy is the treatment of choice, with radiologic interventional techniques gaining ground in the management of this entity.
authors.affiliation: Department of Surgery, Warrington Hospital, Warrington and Halton Hospitals N.H.S. Foundation Trust, Warrington, WA5 1QG, United Kingdom.
authors.forename: Christos
authors.initials: C
authors.lastname: Skouras
authors.forename: Miltiadis A
authors.initials: MA
authors.lastname: Lalountas
authors.forename: Apostolos
authors.initials: A
authors.lastname: Triantafyllou
authors.forename: Stamatia
authors.initials: S
authors.lastname: Angelidou
authors.forename: Konstantinos D
authors.initials: KD
authors.lastname: Ballas
references.citation: J Cardiovasc Surg (Torino). 1971 Jul-Aug;12(4):309-22
references.pmid: 5171538
references.citation: Cardiovasc Intervent Radiol. 1995 Jan-Feb;18(1):56-8
references.pmid: 7788636
references.citation: Arch Intern Med. 2001 Apr 9;161(7):1009-10
references.pmid: 11295967
references.citation: Eur J Vasc Endovasc Surg. 2000 Aug;20(2):198-200
references.pmid: 10942694
references.citation: Am Surg. 2001 Apr;67(4):374-6
references.pmid: 11308008
references.citation: Surg Today. 2009;39(2):144-7
references.pmid: 19198994
references.citation: Surgery. 1980 Nov;88(5):625-30
references.pmid: 7434202
references.citation: Am J Surg. 2000 Jun;179(6):486-9
references.pmid: 11004337
references.citation: Cardiovasc Intervent Radiol. 1994 May-Jun;17(3):167-9
references.pmid: 8087836
references.citation: Surg Today. 2001;31(7):660-4
references.pmid: 11495164
references.citation: J Emerg Med. 2011 Mar;40(3):e49-52
references.pmid: 18687563
references.citation: Am J Gastroenterol. 1995 Mar;90(3):499-501
references.pmid: 7872297
references.citation: Ann R Coll Surg Engl. 1996 Sep;78(5):412-9
references.pmid: 8881722
references.citation: Ann Surg. 1941 Oct;114(4):672-81
references.pmid: 17857902
references.citation: Surg Today. 2009;39(8):721-4
references.pmid: 19639443
references.citation: Dis Colon Rectum. 1976 Nov-Dec;19(8):671-4
references.pmid: 1086764