title: Unusual upper gastrointestinal bleeding: Ruptured superior mesenteric artery aneurysm in rheumatoid arthritis.
abstract: 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.
authors.affiliation: Department of Gastroenterology, Changhua Christian Hospital, Changhua 500, Taiwan.
authors.forename: Chung-Ho
authors.initials: CH
authors.lastname: Choo
authors.forename: Hsu-Heng
authors.initials: HH
authors.lastname: Yen
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D001172:Arthritis, Rheumatoid / Q000150:complications*; D004386:Duodenum / Q000098:blood supply* / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000601:surgery; D012422:Rupture, Spontaneous; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Aneurysm; Duodenum; Endoscopy; Gastrointestinal bleeding; Rheumatoid arthritis
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