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Introduction: Segmental arterial mediolysis (SAM) is a rare, non-atherosclerotic, non-inflammatory vascular disease mostly affecting medium to large sized abdominal arteries which may cause aneurysms, stenosis, and haemorrhage. Report: A case is reported of a patient with SAM affecting the renal arteries bilaterally, where the diagnosis was made by excluding other inflammatory, immunological, and infectious mimickers. Discussion: As SAM carries a significant mortality and morbidity from end organ ischaemia, infarction, or haemorrhage, it should be considered in any patient presenting with abdominal pain. Keywords: Segmental, Arterial, Mediolysis, Vasculopathy, Haemorrhage