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Arch Surg. 2009;144(5):484.

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Answer: Superior Mesenteric Artery Aneurysm

The patient was urgently taken to the operating room. Intraoperative angiography failed to visualize the aneurysm despite multiple selective views of the celiac trunk, superior mesenteric artery (SMA), and renal arteries. However, a displacement of the SMA branches secondary to the mass effect was identified with 1 of the arterial arcades sharply cutting off above the area of the largest vascular paucity. On transabdominal exploration, a large nonpulsatile mass in the middle portion of the jejunal mesentery was encountered, consistent with a thrombus-filled aneurysm (Figure 3). It was sharply dissected, and proximal and distal vascular control was obtained. The aneurysm sac was opened, a large amount of thrombus was evacuated, and a single feeding branch of the SMA was identified. This vessel was repaired from the inside using a fine Prolene suture (Ethicon Inc, Somerville, New Jersey). The entire bowel was closely inspected and no evidence of bowel . . . [Full Text of this Article]

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Arch Surg. 2009;144(5):483.
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