Pediatr Radiol (2006) 36: 268–271 DOI 10.1007/s00247-005-0078-x CASE REPORT Susanne Oechsle . Kurt Vollert . Wolfgang Buecklein . Wolfgang Michl . Frank W. Roemer Percutaneous treatment of a ruptured superior mesenteric artery aneurysm in a child Received: 25 August 2005 / Revised: 13 November 2005 / Accepted: 14 November 2005 / Published online: 24 January 2006 # Springer-Verlag 2006 Abstract Splanchnic artery aneurysms are very rare in children. We report a 10-year-old girl with a large atrau- matic ruptured superior mesenteric artery aneurysm that was considered inoperable. She was ultimately treated with two percutaneous US-guided thrombin injections, which led to complete occlusion of the aneurysm. The aetiology of the aneurysm remained unclear, but a family history was suggestive of a congenital connective tissue disease such as Ehlers-Danlos syndrome subtype IV. Keywords Artery . Aneurysm . Treatment . Intervention . Ultrasound . Child Introduction Splanchnic artery aneurysms are uncommon, accounting for 0.1–0.2% of all aneurysms in autopsy statistics [1]. Most (60%) are located in the splenic artery, followed by the hepatic artery (20%) [2]; aneurysms of the superior mesenteric artery (SMA) and its branches are reported in 8% of all splanchnic artery aneurysms [3]. The majority of SMA aneurysms are of atherosclerotic origin and are observed in men older than 50 years [4]. To date there has been only one report of this condition in a child without a stated underlying cause [5]. Percutaneous injection of thrombin has evolved as a successful non-invasive treat- ment option for iatrogenic femoral artery pseudoaneurysms [6, 7]. This non-surgical method has also been successfully applied to the treatment of splanchnic artery aneurysms [8, 9]. To our knowledge, this treatment method has not been described in visceral artery aneurysms in children. We pres- ent a 10-year-old girl with a ruptured superior mesenteric artery aneurysm who underwent percutaneous treatment. Case report A 10-year-old girl was admitted with acute abdominal pain. The history revealed no recent trauma; she had suffered from an upper respiratory tract infection for 3 days prior to admission. Abdominal US (Fig. 1) showed a ruptured SMA aneu- rysm surrounded by a large retroperitoneal and mesenteric haematoma. To verify the diagnosis, the girl underwent CT angiography (Fig. 2) and digital subtraction mesenteric angiography (Fig. 3). These showed a marginally throm- bosed aneurysm of the SMA, about 2 cm distal from its origin from the abdominal aorta, surrounded by an enor- mous haematoma. The distal SMA branches filled via collateral arteries that were supplied by a jejunal artery originating above the SMA occlusion. There were no signs of active bleeding or intestinal ischaemia. At that stage, surgical intervention was deemed too risky as she was haemodynamically unstable. Regular US follow-up revealed no change in the SMA aneurysm. Persistent severe pain, controlled only by epi- dural anaesthesia, together with the high risk of secondary haemorrhage led to the decision to proceed with an inter- ventional approach. Transluminal therapy such as coiling or stent placement was discussed, but eventually refused because of the high risk of distal ischaemia or secondary rupture of the aneurysm. We decided to treat the girl with a percutaneous US-guided thrombin injection into the aneu- rysm. The potential risk of intestinal ischaemia through possible dislodging of thrombotic material and emboliza- tion of intestinal vessels was acknowledged during the decision process, but the risk of observation without treat- ment was considered to be even higher. At this point in the decision process the aetiology and characteristics of the aneurysm (true aneurysm vs. pseudoaneurysm) were unknown. S. Oechsle (*) . K. Vollert . W. Buecklein . W. Michl . F. W. Roemer Department of Radiology, Klinikum Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany e-mail: susanne_oechsle@yahoo.de Tel.: +49-821-4002441 Fax: +49-821-4003312