Acute multiple lesions resulting from segmental arterial mediolysis: An autopsy case report of subarachnoid hemorrhage accompanied by great omentum bleeding.

RATIONALE: This report describes a rare case of segmental arterial mediolysis (SAM) in a previously healthy man with no known underlying medical conditions. The patient had presented with simultaneous subarachnoid hemorrhage (SAH) and hemorrhage of great omentum, an atypical combination that highlights the diagnostic challenges and severity of SAM. The report outlines the disease's clinical course, autopsy findings, and computed tomography angiography results.

PATIENT CONCERNS: A man in his 40s with no history of chronic illness, presented with symptoms of acute abdomen and intracranial hypertension. Despite receiving medical attention, he died shortly after admission.

DIAGNOSES: The patient was diagnosed with suspected enteritis before his death.

INTERVENTIONS: An autopsy was performed to examine the cause of death.

OUTCOMES: Postmortem examination revealed an acute SAH secondary to a ruptured vertebral artery aneurysm and acute hemorrhage of the greater omentum. The splenic artery was highly tortuous and dilated. Histopathological examination confirmed involvement of the SAH, greater omentum hemorrhage, and splenic artery lesions, suggesting a common underlying vascular pathology for these simultaneous hemorrhagic events.

LESSONS: The case underscores the diagnostic challenges associated with SAM due to its varied clinical presentations and unpredictable symptom progression. It also emphasizes the importance of early detection and treatment of SAM for the prevention of further complications.