Photoclinic Diagnosis: Superior Mesenteric Artery Aneurysm

A54-year-old man was referred to our hospital because of severe excruciating acute colicky central abdominal pain. The pain was associated with nausea, postprandial vomiting, and constipation. He had history of 15 kg weight loss during the last two months. He was opium addict, and cigarettes smoker (20 packsyear) with a negative history of diabetes mellitus and hypertension. He underwent a surgical operation two months before, when he had a similar attack of abdominal pain. The surgery was then revealed small bowel necrosis for which resection of 30 cm of small bowel was performed. General physical examination was unremarkable. There was mild tenderness in deep palpation of periumbilical area. Laboratory data including serum amylase were reported to be normal. The initial abdominal ultrasonography was normal. Upper gastrointestinal endoscopy and colonoscopy were also normal. On account of his severe abdominal pain, a multislice helical abdominal computerized tomography with contrast was requested