Haemoperitoneum caused by a dissecting aneurysm of the left gastroepiploic artery.

Case report A 79-year-old woman was admitted to hospital suffering from abdominal pain and vomiting. The pain had started in the epigastrium 12 hr earlier, and radiated to both shoulders. She was being treated for atrial fibrillation and hypertension with digoxin, diuretics and methyldopa. She was neither pyrexial nor shocked (BP 140/ 70 mmHg). The upper abdomen was slightly tender and bowel sounds were heard. Her haemoglobin concentration was 10-8 g/dl, the white cell count 14 x 109/l and the serum amylase was normal. Cholelithiasis was diagnosed and she was treated conservatively. During the next twelve hours the pain increased and she became shocked (BP 100/60 mmHg) with generalized peritonitis. This was now thought to be caused by mesenteric ischaemia and after energetic resuscitation a laparotomy was performed. Two litres of blood were present in the abdominal cavity and a haematoma was found high in the greater omentum. associated with a ruptured aneurysm of the left gastro-epiploic artery. Four centimetres of artery were excised between ligatures. The patient subsequently made a good recovery. The specimen showed rupture of a dissecting aneurysm. Sections of the artery were stained with haematoxylin and eosin, Miller's elastic technique and the Alcian blue-van Giesson technique. The latter revealed foci of mucoid medial degeneration (Symmers, 1976).