51
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Leow KS, Chieng JSL, Low HM, Lim KS, Kwek JW, Lim TC, Tan CH. Algorithm-based approach to hypervascular pancreatic lesions. Singapore Med J 2021; 62:113-119. [PMID: 33846754 DOI: 10.11622/smedj.2021027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Kheng Song Leow
- Department of Diagnostic Radiology, Woodlands Health Campus, Singapore
| | | | - Hsien Min Low
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | | | - Jin Wei Kwek
- Division of Oncology Imaging, National Cancer Centre Singapore, Singapore
| | - Tze Chwan Lim
- Department of Diagnostic Radiology, Woodlands Health Campus, Singapore
| | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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52
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Fatal rupture of giant splenic artery pseudoaneurysm. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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53
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Giant pseudoaneurysm of the splenic artery within walled of pancreatic necrosis on the grounds of chronic pancreatitis. Hepatobiliary Pancreat Dis Int 2021; 20:87-89. [PMID: 32234361 DOI: 10.1016/j.hbpd.2020.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 02/20/2020] [Indexed: 02/05/2023]
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54
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Shah J, Samanta J, Muktesh G, Kumar N, Gupta P, Kumar KH, Kochhar R. Primary EUS-guided therapy of a giant visceral artery pseudoaneurysm: Expanding horizons (with video). Endosc Ultrasound 2021; 10:307-308. [PMID: 33586691 PMCID: PMC8411556 DOI: 10.4103/eus-d-20-00210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jimil Shah
- Department of Gastroenterology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayanta Samanta
- Department of Gastroenterology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Muktesh
- Department of Gastroenterology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Kumar
- Department of Gastroenterology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Gastroenterology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Hemanth Kumar
- Department of General Surgery, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
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55
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Northup PG, Garcia-Pagan JC, Garcia-Tsao G, Intagliata NM, Superina RA, Roberts LN, Lisman T, Valla DC. Vascular Liver Disorders, Portal Vein Thrombosis, and Procedural Bleeding in Patients With Liver Disease: 2020 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2021; 73:366-413. [PMID: 33219529 DOI: 10.1002/hep.31646] [Citation(s) in RCA: 249] [Impact Index Per Article: 83.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Patrick G Northup
- Division of Gastroenterology and Hepatology, Center for the Study of Hemostasis in Liver Disease, University of Virginia, Charlottesville, VA
| | - Juan Carlos Garcia-Pagan
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.,Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE-Liver), Barcelona, Spain
| | - Guadalupe Garcia-Tsao
- Department of Internal Medicine, Section of Digestive Diseases, Yale University, New Haven, CT.,Veterans Administration Healthcare System, West Haven, CT
| | - Nicolas M Intagliata
- Division of Gastroenterology and Hepatology, Center for the Study of Hemostasis in Liver Disease, University of Virginia, Charlottesville, VA
| | - Riccardo A Superina
- Department of Transplant Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Lara N Roberts
- Department of Haematological Medicine, King's Thrombosis Centre, King's College Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Ton Lisman
- Section of Hepatobiliary Surgery and Liver Transplantation, Surgical Research Laboratory, Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Dominique C Valla
- Hepatology Service, Hospital Beaujon, Clichy, France.,Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN RARE-Liver), Barcelona, Spain
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56
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Holt JN, Schwalb HE. A case of splenic artery pseudoaneurysm rupture presenting as rectal bleeding in a regional hospital. J Surg Case Rep 2020; 2020:rjaa504. [PMID: 33365119 PMCID: PMC7745148 DOI: 10.1093/jscr/rjaa504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/18/2020] [Indexed: 12/02/2022] Open
Abstract
Splenic artery pseudoaneurysm is a rare phenomenon most associated with chronic pancreatitis or previous trauma. Complications can include erosion and rupture into local structures, a situation that carries a reported mortality of 10–40%. A 58-year-old male with chronic alcoholic pancreatitis and a known splenic artery pseudoaneurysm presented to the emergency department of a regional hospital with rectal bleeding and sepsis. Computed tomography revealed a peri-splenic mass communicating with the splenic flexure. The patient was taken for an emergency splenectomy and left hemicolectomy and was confirmed to have rupture of the splenic artery aneurysm into the large bowel. This case presented with comparable features reported in the literature and demonstrates that access to emergency specialist surgical services in a regional setting offers the capability to manage rare, life threatening surgical emergencies.
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Affiliation(s)
- Jonathon N Holt
- General Surgery Department, Albury-Wodonga Health, Albury, NSW, Australia
| | - Heinrich E Schwalb
- General Surgery Department, Albury-Wodonga Health, Albury, NSW, Australia
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57
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Shreve L, Jarmakani M, Javan H, Babin I, Nelson K, Katrivesis J, Lekawa M, Kuncir E, Fernando D, Abi-Jaoudeh N. Endovascular management of traumatic pseudoaneurysms. CVIR Endovasc 2020; 3:88. [PMID: 33245433 PMCID: PMC7695774 DOI: 10.1186/s42155-020-00182-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/17/2020] [Indexed: 01/17/2023] Open
Abstract
Background Pseudoaneurysms (PAs) caused by traumatic injury to the arterial vasculature have a high risk of rupture, leading to life-threatening hemorrhage and mortality, requiring urgent treatment. The purpose of this study was to determine the technical and clinical outcomes of endovascular treatment of visceral and extremity traumatic pseudoaneurysms. Methods Clinical data were retrospectively collected from all patients presenting for endovascular treatment of PAs between September 2012 and September 2018 at a single academic level one trauma center. Technical success was defined as successful treatment of the PA with no residual filling on post-embolization angiogram. Clinical success was defined as technical successful treatment with no rebleeding throughout the follow-up period and no reintervention for the PA. Results Thirty-five patients (10F/25M), average age (± stdev) 41.7 ± 20.1 years, presented with PAs secondary to blunt (n = 31) or penetrating (n = 4) trauma. Time from trauma to intervention ranged from 2 h - 75 days (median: 4.4 h, IQR: 3.5–17.1 h) with 27 (77%) of PAs identified and treated within 24 h of trauma. Average hospitalization was 13.78 ± 13.4 days. Ten patients underwent surgery prior to intervention. PA number per patient ranged from 1 to 5 (multiple diffuse). PAs were located on the splenic (n = 12, 34.3%), pelvic (n = 11, 31.4%), hepatic (n = 9, 25.7%), upper extremity/axilla (n = 2, 5.7%), and renal arteries (n = 1, 2.9%). Technical success was 85.7%. Clinical success was 71.4%, for technical failure (n = 5), repeat embolization (n = 1) or post-IR surgical intervention (n = 4). There was no PA rebleeding or reintervention for any patient after discharge over the reported follow-up periods. Three patients died during the trauma hospitalization for reasons unrelated to the PAs. Conclusions Endovascular treatment of traumatic visceral and extremity PAs is efficacious with minimal complication rates and low reintervention requirements.
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Affiliation(s)
- Lauren Shreve
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rm 115 Rte 140, Orange, CA, 92868, USA
| | - Maha Jarmakani
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rm 115 Rte 140, Orange, CA, 92868, USA
| | - Hanna Javan
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rm 115 Rte 140, Orange, CA, 92868, USA
| | - Ivan Babin
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rm 115 Rte 140, Orange, CA, 92868, USA
| | - Kari Nelson
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rm 115 Rte 140, Orange, CA, 92868, USA
| | - James Katrivesis
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rm 115 Rte 140, Orange, CA, 92868, USA
| | - Michael Lekawa
- Department of Trauma Surgery, University of California, Irvine, Irvine, California, USA
| | - Eric Kuncir
- Department of Trauma Surgery, University of California, Irvine, Irvine, California, USA
| | - Dayantha Fernando
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rm 115 Rte 140, Orange, CA, 92868, USA
| | - Nadine Abi-Jaoudeh
- Department of Radiological Sciences, University of California, Irvine, 101 The City Drive South, Rm 115 Rte 140, Orange, CA, 92868, USA.
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58
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Mitrovic M, Dugalic V, Kovac J, Tadic B, Milosevic S, Lukic B, Lekic N, Cvetic V. Successful Embolization of Posterior Inferior Pancreaticoduodenal Artery Pseudoaneurysm on the Grounds of Chronic Pancreatitis-Case Report and Literature Review. ACTA ACUST UNITED AC 2020; 56:medicina56110617. [PMID: 33207736 PMCID: PMC7696778 DOI: 10.3390/medicina56110617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 12/18/2022]
Abstract
Pancreatic pseudoaneurysm is a rare but life-threatening clinical entity. In this paper, we present a case of a 74-year-old man, who was admitted to our clinic with a diagnosis of an acute on chronic pancreatitis complicated by walled-off-pancreatic-necrosis, with subsequent development of peripancreatic pseudoaneurysm. After initial conservative management, the patient recovered and was discharged from the hospital. However, he soon returned feeling anxious due to a pulsatile abdominal mass. Abdominal Color–Doppler examination, CT scan, and angiography revealed large pancreatic necrotic collection in the total size of 9 cm, with centrally enhancing area of 3.5 cm that corresponded to pseudoaneurysm originating from the posterior pancreaticoduodenal vascular arcade. Considering the size, location of the pseudoaneurysm, feeding vessel, and poor general patients condition, we opted for minimally invasive treatment. Pseudoaneurysm was successfully managed by endovascular coil embolization, i.e., “sandwich technique”.
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Affiliation(s)
- Milica Mitrovic
- Center for Radiology and Magnetic Resonance Imaging, Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (M.M.); (J.K.); (S.M.); (B.L.); (V.C.)
| | - Vladimir Dugalic
- Department for HPB Surgery, Clinic for Digestive Surgery, Clinical Centre of Serbia, Koste Todorovica Street, No. 6, 11000 Belgrade, Serbia; (V.D.); (N.L.)
- Department for Surgery, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
| | - Jelena Kovac
- Center for Radiology and Magnetic Resonance Imaging, Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (M.M.); (J.K.); (S.M.); (B.L.); (V.C.)
- Department for Radiology, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
| | - Boris Tadic
- Department for HPB Surgery, Clinic for Digestive Surgery, Clinical Centre of Serbia, Koste Todorovica Street, No. 6, 11000 Belgrade, Serbia; (V.D.); (N.L.)
- Department for Surgery, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
- Correspondence: ; Tel.: +381-62-388-288
| | - Stefan Milosevic
- Center for Radiology and Magnetic Resonance Imaging, Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (M.M.); (J.K.); (S.M.); (B.L.); (V.C.)
| | - Borivoje Lukic
- Center for Radiology and Magnetic Resonance Imaging, Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (M.M.); (J.K.); (S.M.); (B.L.); (V.C.)
- Department for Radiology, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
| | - Nebojsa Lekic
- Department for HPB Surgery, Clinic for Digestive Surgery, Clinical Centre of Serbia, Koste Todorovica Street, No. 6, 11000 Belgrade, Serbia; (V.D.); (N.L.)
- Department for Surgery, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
| | - Vladimir Cvetic
- Center for Radiology and Magnetic Resonance Imaging, Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia; (M.M.); (J.K.); (S.M.); (B.L.); (V.C.)
- Department for Radiology, Faculty of Medicine, University of Belgrade, Dr Subotica No. 8, 11000 Belgrade, Serbia
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59
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Gajjar B, Aasen T, Goenka P, Gayam V. Massive Upper Gastrointestinal Bleeding Following LAMS (Lumen-Apposing Metal Stent) Placement. J Investig Med High Impact Case Rep 2020; 8:2324709620965800. [PMID: 33054441 PMCID: PMC7570288 DOI: 10.1177/2324709620965800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Pancreatic pseudocyst is a common complication of pancreatitis. Pseudocysts may require decompression when they become painful, infected, or start compressing surrounding organs. Decompression is achieved by endoscopic cystogastrostomy. Recently, the use of lumen-apposing metal stent (LAMS) for cystogastrostomy has gained popularity due to ease of use and high technical success. LAMS has a wider lumen, which allows for direct endoscopic necrosectomy in the cases of walled-off necrosis. Our patient is a 30-year-old male who presented with massive hematemesis and dizziness. He had a history of chronic alcohol-induced pancreatitis. Three weeks before the presentation, he underwent a cystogastrostomy with LAMS placement to treat a 10-cm walled-off necrosis. Urgent computed tomography (CT) scan did not reveal any acute finding suggestive of bleeding. Esophagogastroduodenoscopy showed blood protruding from the LAMS with a large clot formation. Attempts to stop bleeding were unsuccessful. He underwent CT angiography of the abdomen. CT angiography showed a bleeding pseudoaneurysm (PA) believed to be a complication of the LAMS. Subsequently, multiple coils were placed in the splenic artery near the PA. The patient continued to improve without a further drop in hemoglobin and was eventually discharged. PA formation and subsequent rupture is a rare delayed complication of LAMS. It may lead to massive gastrointestinal bleeding with a high mortality rate. Diagnostic delays have resulted in increased mortality by 60%. In this article, we present a case of massive gastrointestinal bleeding due to a ruptured splenic artery PA presenting as a delayed complication of LAMS.
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Affiliation(s)
| | - Tyler Aasen
- East Tennessee State University, Johnson City, TN, USA
| | - Puneet Goenka
- East Tennessee State University, Johnson City, TN, USA
| | - Vijay Gayam
- Interfaith Medical Center, Brooklyn, NY, USA
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60
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Liyen Cartelle A, Uy PP, Yap JEL. Acute Gastric Hemorrhage due to Gastric Cancer Eroding Into a Splenic Artery Pseudoaneurysm: Two Dangerously Rare Etiologies of Upper Gastrointestinal Bleeding. Cureus 2020; 12:e10685. [PMID: 33133851 PMCID: PMC7593120 DOI: 10.7759/cureus.10685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Splenic artery pseudoaneurysms (SAPs) are rare causes of upper gastrointestinal bleeding (UGIB), with less than 250 reported cases in the literature. The highest incidence of SAPs is in patients with a history of acute or chronic pancreatitis or splenic artery trauma. SAP in the setting of gastric malignancy is an exceedingly rare finding. We present the unusual hospital course of an 82-year-old male with advanced gastric cancer presenting with UGIB secondary to a visceral communication between his known gastric malignancy and a SAP.
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Affiliation(s)
- Anabel Liyen Cartelle
- Gastroenterology and Hepatology, Medical College of Georgia at Augusta University, Augusta, USA
| | - Pearl Princess Uy
- Gastroenterology and Hepatology, Medical College of Georgia at Augusta University, Augusta, USA
| | - John Erikson L Yap
- Gastroenterology and Hepatology, Medical College of Georgia at Augusta University, Augusta, USA
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61
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Zhao H, Wu ZZ, Ou JL, Rao M, Makamure J, Xia HX, Hu HY. Splenic Artery Pseudoaneurysm in Chronic Pancreatitis Causing Obstructive Jaundice: Endovascular Management. Ann Vasc Surg 2020; 76:599.e1-599.e5. [PMID: 32949745 DOI: 10.1016/j.avsg.2020.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/12/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Splenic artery pseudoaneurysm (SAP) around the pancreatic head causing obstructive jaundice is an extremely rare complication but can be life threatening once occurs. This case report is to raise awareness of this catastrophic complication and share our experience of successful endovascular management. METHODS A 47-year-old male with a history of chronic pancreatitis clinically presented with epigastric pain and jaundice. Proximal SAP complicated with obstructive jaundice was confirmed by laboratory and imaging investigations. The SAP was successfully treated by transarterial coil embolization, and the jaundice subsequently improved. RESULTS Abdominal contrast-enhanced computed tomography 11 months after embolization showed complete occlusion and reduction in the volume of the SAP as well as normal biliary tract. CONCLUSIONS SAP complicated with obstructive jaundice should be managed timeously and aggressively once diagnosed, given its potential adverse consequences. Transarterial embolization using the isolation technique may be a safe and effective strategy for treating this disease.
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Affiliation(s)
- Hui Zhao
- Department of Interventional Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhen-Zhong Wu
- Department of Interventional Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jia-Le Ou
- Department of Interventional Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Min Rao
- Department of Interventional Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Joyman Makamure
- Department of Radiology, Hubei Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong-Xia Xia
- Department of Emergency, East Campus, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Hong-Yao Hu
- Department of Interventional Radiology, Renmin Hospital of Wuhan University, Wuhan, China.
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Leung E, Maingard J, Yeh J, Lee MJ, Brooks DM, Asadi H, Burrows DA, Kok HK. Contemporary endovascular management of splenic vascular pathologies. Clin Radiol 2020; 75:960.e23-960.e34. [PMID: 32819705 DOI: 10.1016/j.crad.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
Abstract
The spleen is a commonly injured organ and the splenic vasculature is also susceptible to inflammation and trauma, often resulting in aneurysm formation. Splenic artery aneurysms carry a high risk of rupture and are associated with high mortality and morbidity. Due to the advances in endovascular techniques and devices, endovascular management of splenic vascular pathologies is now considered a first-line strategy. Endovascular embolisation and advance techniques including balloon- or stent-assisted coil embolisation enables minimally invasive management option while preserving splenic function.
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Affiliation(s)
- E Leung
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia.
| | - J Maingard
- Interventional Neuroradiology Service - Monash Imaging, Monash Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - J Yeh
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia
| | - M J Lee
- Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D M Brooks
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia; Interventional Neuroradiology Service - Radiology Department, Austin Hospital, Melbourne, Australia
| | - H Asadi
- Interventional Neuroradiology Service - Monash Imaging, Monash Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia; Interventional Neuroradiology Service - Radiology Department, Austin Hospital, Melbourne, Australia
| | - D A Burrows
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia
| | - H K Kok
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
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63
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A novel technique for treating visceral artery pseudoaneurysm: Selective arterial embolization with cut-inflateddeflated balloon. Anatol J Cardiol 2020; 24:56-59. [PMID: 32628140 PMCID: PMC7414821 DOI: 10.14744/anatoljcardiol.2020.59507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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64
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Chaer RA, Abularrage CJ, Coleman DM, Eslami MH, Kashyap VS, Rockman C, Murad MH. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg 2020; 72:3S-39S. [DOI: 10.1016/j.jvs.2020.01.039] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/18/2022]
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65
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Panzera F, Inchingolo R, Rizzi M, Biscaglia A, Schievenin MG, Tallarico E, Pacifico G, Di Venere B. Giant splenic artery aneurysm presenting with massive upper gastrointestinal bleeding: A case report and review of literature. World J Gastroenterol 2020; 26:3110-3117. [PMID: 32587452 PMCID: PMC7304111 DOI: 10.3748/wjg.v26.i22.3110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/29/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Splenic artery aneurysm (SAA) and pseudoaneurysm are rare vessel’s lesions. Pseudoaneurysm is often symptomatic and secondary to pancreatitis or trauma. True SAA is the most common aneurysm of visceral vessels. In contrast to pseudoaneurysm, SAA is usually asymptomatic until the rupture, with high mortality rate. The clinical onset of SSA’s rupture is a massive life-threatening bleeding with hemodynamic instability, usually into the free peritoneal space and more rarely into the gastrointestinal tract.
CASE SUMMARY We describe the case of a 35-year-old male patient, with negative past medical history, who presented to the emergency department for massive upper gastrointestinal bleeding, severe anemia and hypotension. An esophagogastroduodenoscopy performed in emergency showed a gastric bulging in the greater curvature/posterior wall with a small erosion on its surface, with a visible vessel, but no active bleeding. Endoscopic injection therapy with cyanoacrylate glue was performed. Urgent contrast-enhanced computed tomography was carried out due to the clinical scenario and the unclear endoscopic aspect: The radiological examination showed a giant SAA which was adherent to posterior stomach wall, and some smaller aneurysms of the left gastric and ileocolic artery. Because of the high risk of a two-stage rupture of the giant SAA with dramatic outcome, the patient underwent immediate open surgery with aneurysmectomy, splenectomy and distal pancreatectomy with a good postoperative outcome.
CONCLUSION The management of a ruptured giant SAA into the stomach can be successful with surgical approach.
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Affiliation(s)
- Francesco Panzera
- Division of Gastroenterology, Department of Surgery, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Riccardo Inchingolo
- Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Marina Rizzi
- Division of Gastroenterology, Department of Surgery, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Assunta Biscaglia
- Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Matera 75100, Italy
| | | | - Emilia Tallarico
- Department of Pathology, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Giancarlo Pacifico
- Division of General Surgery, Department of Surgery, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Beatrice Di Venere
- Division of General Surgery, Department of Surgery, Madonna delle Grazie Hospital, Matera 75100, Italy
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66
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Yousaf MN, Chaudhary FS, Ehsan A, Wolff MA, Sittambalam CD. Association of splenic artery pseudoaneurysm with recurrent pancreatitis. J Community Hosp Intern Med Perspect 2020; 10:290-293. [PMID: 32864055 PMCID: PMC7431920 DOI: 10.1080/20009666.2020.1771070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A pseudoaneurysm of the splenic artery (SAP) is a rare entity which is associated with pancreatitis in 52% of cases. In the presence of pancreatitis, the enzymatic damage to the wall of splenic artery results in pseudoaneurysm formation. The clinical presentation is variable and ranges from asymptomatic to hemodynamic instability. The diagnosis of SAP is challenging in the presence of peripancreatic fluid collection or pseudocyst, where CT abdomen can miss small pseudoaneurysms. Angiography is a useful modality to establish a definitive diagnosis. We present a 49-year-old male with a history of recurrent pancreatitis due to alcoholism who presented with acute abdominal pain and was found to have acute pancreatitis. Abdominal CT scan showed a peripancreatic fluid collection and hyperdense lesion at the splenic hilum, which was diagnosed as SAP on angiography. A transcatheter embolization was performed with complete resolution of symptoms thereafter.
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Affiliation(s)
- Muhammad Nadeem Yousaf
- Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, MD, USA.,Department of Internal Medicine, MedStar Good Samaritan Hospital, Baltimore, MD, USA.,Department of Internal Medicine, Medstar Franklin Square Medical Center, Baltimore, MD, USA
| | - Fizah S Chaudhary
- Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, MD, USA.,Department of Internal Medicine, MedStar Good Samaritan Hospital, Baltimore, MD, USA.,Department of Internal Medicine, Medstar Franklin Square Medical Center, Baltimore, MD, USA
| | - Amrat Ehsan
- Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, MD, USA.,Department of Internal Medicine, MedStar Good Samaritan Hospital, Baltimore, MD, USA.,Department of Internal Medicine, Medstar Franklin Square Medical Center, Baltimore, MD, USA
| | - Marcos A Wolff
- Department of Infectious Diseases, Medstar Franklin Square Medical Center, Baltimore, MD, USA
| | - Charmian D Sittambalam
- Department of Internal Medicine, Medstar Franklin Square Medical Center, Baltimore, MD, USA.,Department of Internal Medicine, Georgetown University Medical Center, Washington, DC, USA
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67
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Marjara J, Al Juboori A, Aggarwal A, Davis RM, Bhat AP. Metalophagia: Splenic artery pseudoaneurysm after foreign body ingestion and retrieval. Radiol Case Rep 2020; 15:1149-1154. [PMID: 32528603 PMCID: PMC7280363 DOI: 10.1016/j.radcr.2020.04.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 02/08/2023] Open
Abstract
Persistent eating of non-nutritive, nonfood substances (Pica) is seen in children and adult patients with psychiatric problems. Ingestion of multiple metallic FBs with resultant bezoar formation is rare. While many FBs are passed without complication, mucosal injury, bleeding, obstruction or perforation can occur in some cases. Endoscopic FB removal is performed in 20% of patients following FB ingestion. Generally, these are safe procedures, and very effective in extracting ingested FBs. We report, a 25-year-old male patient with a metal ingestion predominant Pica, requiring multiple prior extraction procedures (including open gastrostomy). He developed a splenic artery pseudoaneurysm following his latest endoscopic FB removal, that was successfully treated with transarterial coil embolization. The unique circumstances leading to this rare complication and its successful endovascular management make this case worthy of report.
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Affiliation(s)
- Jasraj Marjara
- University of Missouri-Columbia School of Medicine, One Hospital Drive, Columbia, MO 65212, USA
| | - Alhareth Al Juboori
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
| | - Arpit Aggarwal
- Department of Psychiatry, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
| | - Ryan M Davis
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
| | - Ambarish P Bhat
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
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68
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Montrief T, Anwar Parris M, Auerbach JS, Scott JM, Cabrera J. Spontaneous Splenic Artery Pseudoaneurysm Rupture Causing Hemorrhagic Shock. Cureus 2020; 12:e8286. [PMID: 32601561 PMCID: PMC7317116 DOI: 10.7759/cureus.8286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Splenic artery pseudoaneurysm (SAP) is an uncommon etiology of acute abdominal pain, requiring a high degree of clinical suspicion to diagnose in a timely manner. There are currently no reports of spontaneous SAP ruptures in the emergency medicine literature. We report a case of a man who presented with acute abdominal pain secondary to an SAP. A computed tomography angiography scan of the abdomen revealed a ruptured SAP with hemoperitoneum. He successfully underwent emergency laparotomy and surgical ligation of his SAP with splenectomy. SAP rupture remains an under-recognized etiology of abdominal pain, even though it is the most frequent type of visceral pseudoaneurysm. Our case herein reinforces the importance of a broad list of differential diagnoses in the patient with acute abdominal pain, as well as the importance of the emergency physician in identifying an emergent condition and then directing the initial stabilization, resuscitation, and management.
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Affiliation(s)
- Tim Montrief
- Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | | | - Jonathan S Auerbach
- Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Jeffrey M Scott
- Cardiothoracic and Transplant Critical Care, Miami Transplant Institute, Miami, USA
| | - Jorge Cabrera
- Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, USA
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69
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Maatman TK, Heimberger MA, Lewellen KA, Roch AM, Colgate CL, House MG, Nakeeb A, Ceppa EP, Schmidt CM, Zyromski NJ. Visceral artery pseudoaneurysm in necrotizing pancreatitis: incidence and outcomes. Can J Surg 2020; 63:E272-E277. [PMID: 32436687 DOI: 10.1503/cjs.009519] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Visceral artery pseudoaneurysms (VA-PSA) occur in necrotizing pancreatitis; however, little is known about their natural history. This study sought to evaluate the incidence and outcomes of VA-PSA in a large cohort of patients with necrotizing pancreatitis. Methods Data for patients with necrotizing pancreatitis who were treated between 2005 and 2017 at Indiana University Health University Hospital and who developed a VA-PSA were reviewed to assess incidence, presentation, treatment and outcomes. Results Twenty-eight of 647 patients with necrotizing pancreatitis (4.3%) developed a VA-PSA between 2005 and 2017. The artery most commonly involved was the splenic artery (36%), followed by the gastroduodenal artery (24%). The most common presenting symptom was bloody drain output (32%), followed by incidental computed tomographic findings (21%). The median time from onset of necrotizing pancreatitis to diagnosis of a VA-PSA was 63.5 days (range 1-957 d). Twenty-five of the 28 patients who developed VA-PSA (89%) were successfully treated with percutaneous angioembolization. Three patients (11%) required surgery: 1 patient rebled following embolization and required operative management, and 2 underwent upfront operative management. The mortality rate attributable to hemorrhage from a VA-PSA in the setting of necrotizing pancreatitis was 14% (4 of 28 patients). Conclusion In this study, VA-PSA occurred in 4.3% of patients with necrotizing pancreatitis. Percutaneous angioembolization effectively treated most cases; however, mortality from VA-PSA was high (14%). A high degree of clinical suspicion remains critical for early diagnosis of this potentially fatal problem.
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Affiliation(s)
- Thomas K Maatman
- From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Maatman, Roch, House, Nakeed, Ceppa, Schmidt, Zyromski); the Indiana University School of Medicine, Indianapolis, Indiana (Heimberger, Lewellen); and the Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, Indiana (Colgate)
| | - Mark A Heimberger
- From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Maatman, Roch, House, Nakeed, Ceppa, Schmidt, Zyromski); the Indiana University School of Medicine, Indianapolis, Indiana (Heimberger, Lewellen); and the Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, Indiana (Colgate)
| | - Kyle A Lewellen
- From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Maatman, Roch, House, Nakeed, Ceppa, Schmidt, Zyromski); the Indiana University School of Medicine, Indianapolis, Indiana (Heimberger, Lewellen); and the Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, Indiana (Colgate)
| | - Alexandra M Roch
- From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Maatman, Roch, House, Nakeed, Ceppa, Schmidt, Zyromski); the Indiana University School of Medicine, Indianapolis, Indiana (Heimberger, Lewellen); and the Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, Indiana (Colgate)
| | - Cameron L Colgate
- From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Maatman, Roch, House, Nakeed, Ceppa, Schmidt, Zyromski); the Indiana University School of Medicine, Indianapolis, Indiana (Heimberger, Lewellen); and the Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, Indiana (Colgate)
| | - Michael G House
- From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Maatman, Roch, House, Nakeed, Ceppa, Schmidt, Zyromski); the Indiana University School of Medicine, Indianapolis, Indiana (Heimberger, Lewellen); and the Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, Indiana (Colgate)
| | - Attila Nakeeb
- From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Maatman, Roch, House, Nakeed, Ceppa, Schmidt, Zyromski); the Indiana University School of Medicine, Indianapolis, Indiana (Heimberger, Lewellen); and the Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, Indiana (Colgate)
| | - Eugene P Ceppa
- From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Maatman, Roch, House, Nakeed, Ceppa, Schmidt, Zyromski); the Indiana University School of Medicine, Indianapolis, Indiana (Heimberger, Lewellen); and the Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, Indiana (Colgate)
| | - C Max Schmidt
- From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Maatman, Roch, House, Nakeed, Ceppa, Schmidt, Zyromski); the Indiana University School of Medicine, Indianapolis, Indiana (Heimberger, Lewellen); and the Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, Indiana (Colgate)
| | - Nicholas J Zyromski
- From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Maatman, Roch, House, Nakeed, Ceppa, Schmidt, Zyromski); the Indiana University School of Medicine, Indianapolis, Indiana (Heimberger, Lewellen); and the Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, Indiana (Colgate)
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70
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Musselwhite CC, Mitta M, Sternberg M. Splenic Artery Pseudoaneurysm. J Emerg Med 2020; 58:e231-e232. [PMID: 32265068 DOI: 10.1016/j.jemermed.2020.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/09/2020] [Accepted: 02/16/2020] [Indexed: 06/11/2023]
Affiliation(s)
| | - Monica Mitta
- Department of Emergency Medicine, University of South Alabama University Hospital, Mobile, Alabama
| | - Michael Sternberg
- Department of Emergency Medicine, University of South Alabama University Hospital, Mobile, Alabama
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71
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Initial experience with 3D CT cinematic rendering of acute pancreatitis and associated complications. Abdom Radiol (NY) 2020; 45:1290-1298. [PMID: 31696270 DOI: 10.1007/s00261-019-02310-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Inflammation of the pancreas can present with a wide range of imaging findings from mild enlargement of the gland and surrounding infiltrative fat stranding through extensive glandular necrosis. Complications of pancreatitis are varied and include infected fluid collections, pseudocysts, and vascular findings such as pseudoaneurysms and thromboses. Cross-sectional imaging with computed tomography (CT) is one of the mainstays of evaluating patients with pancreatitis. New methods that allow novel visualization volumetric CT data may improve diagnostic yield for the detection of findings that provide prognostic information in pancreatitis patients or can drive new avenues of research such as machine learning. Cinematic rendering (CR) is a photorealistic visualization method for volumetric imaging data that are being investigated for a variety of potential applications including the life-like display of complex anatomy and visual characterization of mass lesions. In this review, we describe the CR appearance of different types of pancreatitis and complications of pancreatitis. We also note possible future directions for research into the utility of CR for pancreatitis.
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72
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Chen R, Pande G, Johnson MA. Splenic Artery Pseudoaneurysm Causing Massive Hematemesis 10 Years After Necrotizing Pancreatitis. Vasc Endovascular Surg 2020; 54:455-457. [PMID: 32319352 DOI: 10.1177/1538574420921004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a case of a 54-year-old male presenting to a regional hospital with severe hematemesis and hemodynamic instability. His medical history was significant for a previous episode of alcoholic necrotizing pancreatitis and pseudocyst, requiring cystoenterostomy drainage and debridement 10 years prior. He underwent multiple gastroscopies and one emergency laparotomy which failed to definitively treat the bleeding. A splenic artery pseudoaneurysm was diagnosed with computed tomography angiography, adjacent to the previous cystoenterostomy site. The patient was transferred to a major tertiary center with access to interventional radiology and underwent successful embolization of the pseudoaneurysm.
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Affiliation(s)
- Reuben Chen
- Upper Gastrointestinal and Hepatobiliary Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Girish Pande
- Department of Surgery, Launceston General Hospital, Tasmania, Australia
| | - Mary Ann Johnson
- Upper Gastrointestinal and Hepatobiliary Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.,Upper Gastrointestinal and Hepatobiliary Surgery, Royal Melbourne Hospital, Victoria, Australia
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73
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Ter-Akopian AV, Kalinin AA, Kriuchkova OV, Abramov AS, Tagaev NB. [Embolization of a pseudoaneurysm of the inferior gastroduodenal artery]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2020; 26:138-142. [PMID: 32240149 DOI: 10.33529/angio2020122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Aneurysms and pseudoaneurysms of visceral arteries are relatively rare clinical entities and their pathogenesis has not yet been fully understood. Aneurysmal rupture appears to be a complication leading to life-threatening internal haemorrhage and is a cause of high mortality. However, advances in endovascular surgery techniques have extended the capabilities of treating aneurysms, allowing microemboli to be delivered even to the hard-to-reach portions of the vascular bed with complicated anatomy. Presented in the article is a clinical case report regarding embolization of a false aneurysm of the inferior gastrointestinal artery, separated by a microcoil, and demonstrating possibilities of endovascular superselective embolization of the target vessel.
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Affiliation(s)
- A V Ter-Akopian
- Department of Roentgenosurgical Methods of Diagnosis and Treatment, Central Clinical Hospital and Polyclinic of the RF President's Affairs Administration, Moscow, Russia
| | - A A Kalinin
- Department of Roentgenosurgical Methods of Diagnosis and Treatment, Central Clinical Hospital and Polyclinic of the RF President's Affairs Administration, Moscow, Russia
| | - O V Kriuchkova
- Department of Roentgenosurgical Methods of Diagnosis and Treatment, Central Clinical Hospital and Polyclinic of the RF President's Affairs Administration, Moscow, Russia
| | - A S Abramov
- Department of Roentgenosurgical Methods of Diagnosis and Treatment, Central Clinical Hospital and Polyclinic of the RF President's Affairs Administration, Moscow, Russia
| | - N B Tagaev
- Department of Roentgenosurgical Methods of Diagnosis and Treatment, Central Clinical Hospital and Polyclinic of the RF President's Affairs Administration, Moscow, Russia
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74
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Hamid HKS, Suliman AEA, Spiliopoulos S, Zabicki B, Tetreau R, Piffaretti G, Tozzi M. Giant Splenic Artery Pseudoaneurysms: Two Case Reports and Cumulative Review of the Literature. Ann Vasc Surg 2020; 64:382-388. [PMID: 31676381 DOI: 10.1016/j.avsg.2019.10.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Giant splenic artery pseudoaneurysms (GSAPs) > 5 cm are a rare clinical entity. The aim of this study was to present our experience with 2 such patients successfully treated by coil embolization and surgery and review the pertinent literature. METHODS A 58-year-old woman and 57-year-old man with a history of chronic pancreatitis were diagnosed with GSAP based on computed tomography (CT) angiography. The first patient had a 6-cm pseudoaneurysm, which was successfully treated with transcatheter coil embolization using a sandwich exclusion method. The second patient had two 7-cm lesions, which were successfully treated with distal pancreatectomy and splenectomy. RESULTS Postembolization CT angiography at 12 months showed remaining calcified pseudocyst without evidence of pseudoaneurysm in the first patient. Both patients remained well and symptom-free at 12 months. CONCLUSIONS Combined with the experience of the previous literature, we believe that management of GSAP should be tailored for each individual case depending on the location and number of pseudoaneurysms, the underlying etiology, and the patient's hemodynamic status. Embolization should be considered as the first-line treatment for clinically stable patients with GSAP, whereas GSAPs with a pseudocyst are best treated with surgery.
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Affiliation(s)
- Hytham K S Hamid
- Department of Surgery, Soba University Hospital, Khartoum, Sudan.
| | | | - Stavros Spiliopoulos
- Department of Diagnostic and Interventional Radiology, Patras University Hospital, Rion, Greece
| | - Bartosz Zabicki
- Department of Diagnostic and Interventional Radiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Raphael Tetreau
- Centre d'Imagerie Médicale, Institut du Cancer, Montpellier, France
| | - Gabriele Piffaretti
- Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Matteo Tozzi
- Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
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75
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Vittoria De Martini I, Pfammatter T, Puippe G, Clavien PA, Alkadhi H. Frequency and causes of delayed diagnosis of visceral artery pseudoaneurysms with CT: Lessons learned. Eur J Radiol Open 2020; 7:100221. [PMID: 32099872 PMCID: PMC7026741 DOI: 10.1016/j.ejro.2020.100221] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 11/27/2022] Open
Abstract
Objective Visceral artery pseudoaneurysms (VAPA) are associated with a high morbidity and mortality, but sometimes are missed in initial computed tomography (CT) examinations. The aims of this study were to determine the frequency and causes of misdiagnoses of VAPA with CT. Materials and Methods We retrospectively identified 77 patients with VAPA in our database who underwent contrast-enhanced CT. The frequency of delayed diagnosis was determined and the reasons were noted. We identified the etiology of VAPA, measured size, and noted the affected vessels. Results Forty-five of the 77 patients (58 %) had a delayed diagnosis of VAPA. There was no difference in the rate of missed VAPA in symptomatic compared to asymptomatic patients (p = 0.255). The majority of VAPA were associated with previous surgery or interventions (n = 48/62 %). The major affected vessel was the hepatic (n = 31) followed by the splenic artery (n = 17). The main reasons for misdiagnosis were a missed arterial phase in CT (n = 16/36 %), artifacts masking the aneurysm (n = 9/20 %), overlooked pseudoaneurysm (n = 19/42 %), and misinterpretation by attending radiologists (n = 1/2 %). Missed VAPA were smaller (median 8 mm) than those VAPA that were initially diagnosed (median 13 mm, p < 0.01), but occurred with a similar frequency in larger and smaller visceral arteries (p = 0.601). Conclusions Our study showed that 58 % of VAPA were diagnosed with delay, with the following four reasons for misdiagnosis: Lack of an arterial contrast phase in CT, no techniques for artifact reduction, and lack of awareness of the radiologists. Avoiding delayed diagnosis will most probably improve outcome of patients with VAPA.
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Affiliation(s)
- Ilaria Vittoria De Martini
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Thomas Pfammatter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Gilbert Puippe
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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76
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Pararas N, Rajendiran S, Taha I, Powar RR, Holguera C, Tadros E. Spontaneous Rupture of a Huge Splenic Artery Aneurysm: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e919956. [PMID: 31980593 PMCID: PMC6998792 DOI: 10.12659/ajcr.919956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Splenic artery aneurysm is uncommon in a healthy young male patient. With spontaneous rupture, it can quickly become life-threatening. Our aim is to highlight the possibility of splenic artery aneurysm among healthy young patients and its presentation as recurrent abdominal pain, while pending rupture is possible, which can present a diagnostic challenge. The rare occurrence and spontaneous rupture of a splenic artery aneurysm are often fatal outside an inpatient setting. CASE REPORT Here, we present the case of a 32-year-old patient who visited the Emergency Department with recurrent epigastric pain. While undergoing inpatient evaluation, had a spontaneous rupture of a splenic artery aneurysm with hypovolemic shock and a double-rupture phenomenon, necessitating emergency surgery. CONCLUSIONS With advances in modern imaging in recent years, the incidence of splenic aneurysm has increased 7-fold; therefore, being informed and considering it in the differential diagnosis might provide a window of opportunity and save lives.
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Affiliation(s)
- Nikolaos Pararas
- Department of Surgery, Dr. Sulaiman Al Habib Hospitals, Riyadh, Saudi Arabia
| | | | - Imad Taha
- Department of Surgery, Dr. Sulaiman Al Habib Hospitals, Riyadh, Saudi Arabia
| | | | - Carlos Holguera
- Department of Radiology, Dr. Sulaiman Al Habib Hospitals, Riyadh, Saudi Arabia
| | - Ezzat Tadros
- Department of Surgery, Dr. Sulaiman Al Habib Hospitals, Riyadh, Saudi Arabia
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77
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Sousa J, Costa D, Mansilha A. Visceral artery aneurysms: review on indications and current treatment strategies. INT ANGIOL 2019; 38:381-394. [DOI: 10.23736/s0392-9590.19.04194-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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78
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Mišović M, Golubović J, Sekulić I, Dragović S, Rančic N. POSSIBILITY OF RADIOLOGICAL DIAGNOSTICS OF SPLENIC ARTERY PSEUDOANEURYSM-A CASE REPORT AND REVIEW OF LITERATURE. ACTA MEDICA MEDIANAE 2019. [DOI: 10.5633/amm.2019.0325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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79
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Interventional treatment options in pseudoaneurysms: different techniques in different localizations. Pol J Radiol 2019; 84:e319-e327. [PMID: 31636766 PMCID: PMC6798774 DOI: 10.5114/pjr.2019.88021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/10/2019] [Indexed: 01/17/2023] Open
Abstract
Pseudoaneurysms are commonly experienced vascular abnormalities. The increase in the number of surgical and arteriographic procedures has caused a higher prevalence of pseudoaneurysms. Conventional angiography is still the gold standard method for diagnosis, but other imaging modalities such as duplex Doppler ultrasonography, magnetic resonance angiography and computed tomographic angiography are useful in noninvasive detection. Over the past few years, interventional radiological treatment has evolved and taken the place of surgery in management. There are different kinds of percutaneous and endovascular treatment methods in pseudoaneurysm management. Treatment options depend on certain conditions. We used a case-based approach to discuss pseudoaneurysms and their appropriate treatment by interventional radiological methods in this article.
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80
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Koutserimpas C, Papachristou E, Nikitakis N, Zannes N, Tellos A, Velimezis G. Spontaneous splenic artery aneurysm rupture in a 38-year old female: a case report. G Chir 2019; 38:205-208. [PMID: 29182904 DOI: 10.11138/gchir/2017.38.4.205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Splenic artery aneurysm (SAA) is a rare and extremely difficult diagnosis. A rare case of a ruptured SAA in a 38-year old female, firstly treated with endovascular embolization and then with splenectomy, is presented. A 38-year old female presented to the emergency department with epigastric pain and fainting episodes. Direct catheter angiography revealed a ruptured SAA and distal, as well as proximal coil embolization was performed. Due to abdominal compartment syndrome the patient underwent open surgery with splenic artery ligation and splenectomy. Postoperative she showed signs of sepsis and was treated with i.v. fluids, steroids, packed red blood cells, platelets, fresh frozen plasma and antimicrobial treatment. Additionally, a multidrug resistant Acinetobacter baumanni was yielded from the urine culture. She had a satisfactory recovery. She is followed up a total of 5 years with no signs of overwhelming post-splenectomy infection syndrome. Direct catheter angiography is a very helpful option in diagnosis, as well as treatment, but a close monitoring after embolization is essential. Furthermore, post-splenectomy sepsis is a severe disease with high mortality rates that requires immediate appropriate treatment.
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81
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Splenic artery pseudoaneurysm presenting with massive rectal bleeding. Radiol Case Rep 2019; 14:791-794. [PMID: 31011381 PMCID: PMC6462799 DOI: 10.1016/j.radcr.2019.03.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 03/28/2019] [Accepted: 03/31/2019] [Indexed: 11/25/2022] Open
Abstract
Splenic artery pseudoaneursym is relatively rare and its rupture is usually fatal. We report a case of a 48-year-old male with 2 prior episodes of alcoholic pancreatitis that presented with massive per rectal bleeding from rupture of a splenic artery pseudoaneurysm into the transverse colon. Gold standard of diagnosis is CT angiography of the abdomen. We present the first case in the literature where a diagnosis has been made with noncontrast CT of the abdomen and described the radiologic features that facilitated this diagnosis.
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82
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Unusual Case of Life-Threatening Gastro Intestinal Bleed from a Splenic Artery Pseudoaneurysm: Case Report and Review of Literature. Case Rep Gastrointest Med 2019; 2019:8528906. [PMID: 30881708 PMCID: PMC6381554 DOI: 10.1155/2019/8528906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/17/2018] [Accepted: 12/02/2018] [Indexed: 11/17/2022] Open
Abstract
Large upper gastro intestinal (GI) bleeding can be life-threatening. Splenic artery pseudoaenurysm (SAP) is rare but can cause massive upper GI bleeding. We report a case of a 57-year-old woman who had massive upper GI bleeding from SAP eroding into distal duodenum. Literature review shows SAP can bleed into stomach or pancreatic pseudocyst or biliary tree and peritoneal cavity; however, there are no previous reported cases of SAP bleeding into distal duodenum. Splenic artery embolization (SAE) is the preferred treatment for a bleeding SAP. Splenic infarcts can result following a SAE.
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83
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Suri K, Tran K, Whang G. Gastric remnant perforation in a gastric bypass patient secondary to splenic artery pseudoaneurysm: radiologic-surgical correlation. Clin Imaging 2019; 54:159-162. [DOI: 10.1016/j.clinimag.2019.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/01/2018] [Accepted: 01/07/2019] [Indexed: 11/15/2022]
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84
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Shimpi TR, Shikhare SN, Chung R, Wu P, Peh WCG. Imaging of Gastrointestinal and Abdominal Emergencies in Binge Drinking. Can Assoc Radiol J 2019; 70:52-61. [PMID: 30691564 DOI: 10.1016/j.carj.2018.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 08/30/2018] [Accepted: 10/20/2018] [Indexed: 12/19/2022] Open
Abstract
Excess alcohol consumption is a leading cause of preventable morbidity and mortality globally. The pattern of consumption of alcoholic beverages has changed in our society in the recent past, with binge drinking becoming more and more common, especially among young adults. Abdominal pain following alcohol consumption can be secondary to a wide range of pathologies, the treatment algorithm of which can range from medical supportive treatment to more invasive life-saving procedures such as transarterial embolization and emergency laparotomy. Correct diagnosis, differentiation among these conditions, and implementing the correct management algorithm is heavily reliant on accurate and appropriate imaging. We review the pathophysiology, clinical presentation, imaging features and management options of acute abdominal emergencies secondary to binge drinking, based on a selection of illustrative cases.
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Affiliation(s)
- Trishna R Shimpi
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore.
| | - Sumer N Shikhare
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
| | - Raymond Chung
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
| | - Peng Wu
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
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85
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Chen G, Yang J, Qian G, Jiang K, Lv Y, Shi N, Zhu T. Spontaneous rupture of a splenic artery aneurysm with splenic epithelioid hemangioendothelioma: a case report. J Int Med Res 2019; 47:1059-1063. [PMID: 30614335 PMCID: PMC6381479 DOI: 10.1177/0300060518819372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Spontaneous rupture of a splenic artery aneurysm with splenic epithelioid hemangioendothelioma is a rare condition. Splenic artery aneurysm can be complicated by rupture resulting in hypovolemic shock, which can be fatal if not treat properly. We report a case of a 50-year-old man who presented with sudden onset of left upper quadrant pain and shock. This patient underwent splenectomy with distal pancreatectomy. His pathological diagnosis showed splenic epithelioid hemangioendothelioma.
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Affiliation(s)
- Ganghong Chen
- 1 Department of General Surgery, The People's Hospital of Zhuji, Zhuji, China
| | - Jing Yang
- 2 Department of Gastroenterology, The First Hospital of HangZhou, Hangzhou Hospital Affiliated to Nanjing Medical University, Hangzhou, China
| | - Guangyu Qian
- 1 Department of General Surgery, The People's Hospital of Zhuji, Zhuji, China
| | - Kexiang Jiang
- 1 Department of General Surgery, The People's Hospital of Zhuji, Zhuji, China
| | - Yanting Lv
- 3 Department of Pathology, The People's Hospital of Zhuji, Zhuji, China
| | - NaiChang Shi
- 4 Department of Radiology, The People's Hospital of Zhuji, Zhuji, Zhejiang Province, China
| | - Tieming Zhu
- 1 Department of General Surgery, The People's Hospital of Zhuji, Zhuji, China
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86
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Zharskiy SL, Rudman VY, Valchenko SM, Revotas AA, Kagramanyan VV, Polyakov AG, Bogatkov SD, Rabinovich EL. [Diagnostics and treatment of large splenic artery aneurysms illustrated by two clinical cases presentation]. Khirurgiia (Mosk) 2018:116-121. [PMID: 30560857 DOI: 10.17116/hirurgia2018121116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors analyze the clinical course of large splenic artery aneurysms (SAA) accidentally identified in two patients. In the first case 4.5×4.0 sm aneurysm was circumstantially discovered while providing the multispiral computer coronary angiography, and it was interpreted as a pancreatic gland cyst. Four years later on the next spiral computer tomography (SCT) provided also under another prescription ASA was found by means of contrast intensifying, and it had reached the size of 5.1×6.3×6.2 sm. In the second patient suffering from hepatic cirrhosis and hospitalized because of esophagogastric bleeding the deforming posterior ventricle wall lump was discovered during the laparotomy and stomach operating exploration. By providing the lump needle punction arterial blood was observed. During the upcoming SCT with contrast intensifying this lump was verified as a saccular SAA sized 7.8×5.7 sm. In both cases the endovascular proximal splenic artery embolization was successfully applied as the treatment.
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Affiliation(s)
- S L Zharskiy
- Federal State Budgetary Educational Institution of Higher Education 'Far-East State Medical University' of the Ministry of Healthcare of the Russian Federation
| | - V Ya Rudman
- Territorial State Budgetary Institution of Healthcare 'Clinical Hospital #2', of the Ministry of Healthcare of the Khabarovsk Territory
| | - S M Valchenko
- Territorial State Budgetary Institution of Healthcare 'Clinical Hospital #2', of the Ministry of Healthcare of the Khabarovsk Territory
| | - A A Revotas
- Territorial State Budgetary Institution of Healthcare 'Clinical Hospital #2', of the Ministry of Healthcare of the Khabarovsk Territory
| | - V V Kagramanyan
- Territorial State Budgetary Institution of Healthcare 'Clinical Hospital #2', of the Ministry of Healthcare of the Khabarovsk Territory
| | - A G Polyakov
- Territorial State Budgetary Institution of Healthcare 'Clinical Hospital #2', of the Ministry of Healthcare of the Khabarovsk Territory
| | - S D Bogatkov
- Territorial State Budgetary Institution of Healthcare 'Clinical Hospital #2', of the Ministry of Healthcare of the Khabarovsk Territory
| | - E L Rabinovich
- Territorial State Budgetary Institution of Healthcare 'Clinical Hospital #2', of the Ministry of Healthcare of the Khabarovsk Territory
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87
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Ibrahim F, Dunn J, Rundback J, Pellerito J, Galmer A. Visceral Artery Aneurysms: Diagnosis, Surveillance, and Treatment. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:97. [PMID: 30367314 DOI: 10.1007/s11936-018-0696-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Visceral artery aneurysms (VAAs) are a rare, but serious clinical entity as rupture confers a high rate of mortality. Data regarding the prevalence, treatment, and prognosis of VAAs is largely from case series, as true randomized trials are lacking. The incidence of VAAs has risen over the decades with advances in imaging technology, availability, and utilization. Even in the presence of symptoms, the prompt diagnosis of VAAs may be challenging as symptoms are often nonspecific and varied. Although there are no definitive treatment guidelines, asymptomatic VAAs require treatment in the following scenarios: when the aneurysm diameter is greater than 2 cm, when identified during pregnancy, when multiple aneurysms are present, and in the case of hepatic transplant. Similar to therapeutic trends in other vascular beds, advances in endovascular devices and techniques have driven an "endovascular first" approach for the treatment of VAAs. However, although the success rates of endovascular repair are impressive, surgical intervention is still necessary in treating centers. This paper reviews the pathophysiology, clinical features, anatomic characteristics, and management strategies required for the effective diagnosis and treatment of VAAs.
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Affiliation(s)
- Fady Ibrahim
- Zucker School of Medicine at Hofstra Northwell, Northshore University Hospital, 300 Community Drive, Manhasset, NY, 11030, USA
| | - Jonathan Dunn
- Zucker School of Medicine at Hofstra Northwell, Northshore University Hospital, 300 Community Drive, Manhasset, NY, 11030, USA
| | - John Rundback
- Holy Name Medical Center, 718 Teaneck Road, Teaneck, NJ, 07666, USA
| | - John Pellerito
- Zucker School of Medicine at Hofstra Northwell, Northshore University Hospital, 300 Community Drive, Manhasset, NY, 11030, USA
| | - Andrew Galmer
- Zucker School of Medicine at Hofstra Northwell, Northshore University Hospital, 300 Community Drive, Manhasset, NY, 11030, USA.
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88
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Bacalbasa N, Balescu I, Tanase A, Pautov M, Brezean I, Vilcu M, Brasoveanu V. Spleno-pancreatectomy En Bloc with Parcelar Gastrectomy for Splenic Artery Aneurysm - A Case Report and Literature Review. In Vivo 2018; 32:915-919. [PMID: 29936480 DOI: 10.21873/invivo.11329] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 02/07/2023]
Abstract
Splenic artery aneurysms are common arterial lesions which might remain asymptomatic for a long period of time. In certain cases, these lesions might encounter a significant growth and might become symptomatic. Once diagnosed, a therapeutic strategy should be taken in consideration in order to avoid the apparition of life-threatening complications such as aneurysmal rupture. This is a case report of a 45-year-old patient diagnosed with a splenic artery aneurysm who was successfully submitted to an aneurysmal resection en bloc with distal spleno-pancreatectomy and parcelar gastrectomy.
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Affiliation(s)
- Nicolae Bacalbasa
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Alina Tanase
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Mihai Pautov
- "Dan Setlacec" Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Iulian Brezean
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"I. Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - Mihaela Vilcu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"I. Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - Vladislav Brasoveanu
- "Dan Setlacec" Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
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89
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Foo ET, Kumar V, Nanavati SM, Huo E, Wilson MW, Conrad MB. Percutaneous embolization of post traumatic splenic pseudoaneurysm. Emerg Radiol 2018; 25:719-722. [PMID: 30155849 DOI: 10.1007/s10140-018-1636-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/16/2018] [Indexed: 11/25/2022]
Abstract
Management of splenic pseudoaneurysms in hemodynamically stable patients has shifted toward nonoperative management, including watchful waiting and endovascular embolization. Standard of treatment does not include percutaneous embolization for splenic pseudoaneurysm repair. In this case report, we document a successful percutaneous embolization of a post traumatic splenic pseudoaneurysm with thrombin. Percutaneous embolization of splenic pseudoaneurysms can be considered a viable technique in patients who fail endovascular embolization or have lesions inaccessible to endovascular repair.
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Affiliation(s)
- Eric T Foo
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street NW, Suite 350, Lobby 6, San Francisco, CA, 94107, USA
| | - Vishal Kumar
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street NW, Suite 350, Lobby 6, San Francisco, CA, 94107, USA
| | - Sujal M Nanavati
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street NW, Suite 350, Lobby 6, San Francisco, CA, 94107, USA
| | - Eugene Huo
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street NW, Suite 350, Lobby 6, San Francisco, CA, 94107, USA
| | - Mark W Wilson
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street NW, Suite 350, Lobby 6, San Francisco, CA, 94107, USA
| | - Miles B Conrad
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street NW, Suite 350, Lobby 6, San Francisco, CA, 94107, USA
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90
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Therakathu J, Panwala HK, Bhargava S, Eapen A, Keshava SN, David D. Contrast-enhanced Computed Tomography Imaging of Splenic Artery Aneurysms and Pseudoaneurysms: A Single-center Experience. J Clin Imaging Sci 2018; 8:37. [PMID: 30197828 PMCID: PMC6118105 DOI: 10.4103/jcis.jcis_21_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 05/21/2018] [Indexed: 11/22/2022] Open
Abstract
AIM The aim of our study was to evaluate the computed tomography (CT) imaging features of splenic artery aneurysm and pseudoaneurysm and to identify the disease conditions related to the same. We also wanted to ascertain any relationship between these associated disease conditions and the imaging features of the aneurysms. MATERIALS AND METHODS This retrospective study included patients diagnosed to have splenic artery aneurysms on contrast-enhanced CT examination between January 2001 and January 2016. Data were obtained from the picture archiving and communication system. The size, number, location, morphology, the presence of thrombosis, calcification, and rupture of the aneurysms were evaluated. RESULTS A total of 45 patients were identified with a mean age of 45 years. Splenic artery aneurysms were idiopathic in 12 (26.6%) patients. In the remaining patients, the main associated disease conditions included pancreatitis 15 (33%), chronic liver disease with portal hypertension 8 (18%), and extrahepatic portal vein obstruction (EHPVO) 6 (13%). Statistically significant findings included the relationship between EHPVO and multiple aneurysms (P = 0.002), chronic liver disease and fusiform aneurysm (P = 0.008), and smaller size of idiopathic aneurysms (P < 0.001). CONCLUSION Based on this study, splenic artery aneurysms were associated with a variety of etiologies. The characteristics of the aneurysms such as size, location, and morphology vary with the associated disease conditions. These variations may have implications for the management.
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Affiliation(s)
- Jacob Therakathu
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Salil Bhargava
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anu Eapen
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Deepu David
- Department of Gastroenterology, Christian Medical College, Vellore, Tamil Nadu, India
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91
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Prette PR, Fagundes FB, Marchon LRC, Maciel RDRT, Martins IM, Riguetti-Pinto CR. Endovascular treatment of acute gastrointestinal bleeding from a large splenic artery pseudoaneurysm: case report and literature review. J Vasc Bras 2018; 17:234-242. [PMID: 30643510 PMCID: PMC6326128 DOI: 10.1590/1677-5449.005517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/19/2018] [Indexed: 11/22/2022] Open
Abstract
Pseudoaneurysm of the splenic artery is a rare entity, with little more than 150 cases described in the literature. Pancreatitis is the most common etiology, followed by trauma. In contrast with true aneurysms, pseudoaneurysms are frequently symptomatic, with a 47% risk of rupture and 90% mortality if left untreated. We describe the case of a 48-year-old female patient who suffered a gastrointestinal hemorrhage associated with acute-on-chronic pancreatitis. During workup, endoscopy revealed signs of recent bleeding and magnetic resonance angiography of the abdomen showed a large pseudoaneurysm of the splenic artery. The patient underwent endovascular treatment with microcoil embolization and no further bleeding episodes occurred. Endovascular treatment is now an effective option with low morbidity and mortality and success rates in the range of 79-100%, making it a viable technique for patients with active abdominal inflammation. We conducted a review of endovascular techniques and embolization agents used to treat this pathology.
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Affiliation(s)
- Paulo Roberto Prette
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
| | - Felipe Borges Fagundes
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
| | - Livia Ramos Carvalho Marchon
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
| | - Rodrigo de Rezende Teixeira Maciel
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
| | - Igor Miguel Martins
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
| | - Cristina Ribeiro Riguetti-Pinto
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
- Curso de Formação em Cirurgia Endovascular – Endocurso, Rio de Janeiro, RJ, Brasil.
- Vascularis Centro de Angiologia e Cirurgia Endovascular, Rio de Janeiro, RJ, Brasil.
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92
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Cho SB, Park SE, Lee CM, Park JH, Baek HJ, Ryu KH, Moon JI, Choi BH, Ha JY, Lee S. Splenic artery pseudoaneurysm with splenic infarction induced by a benign gastric ulcer: A case report. Medicine (Baltimore) 2018; 97:e11589. [PMID: 30024561 PMCID: PMC6086524 DOI: 10.1097/md.0000000000011589] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Splenic artery pseudoaneurysm induced by benign gastric ulcer is extremely rare and can lead to a fatal clinical situation. To the best of our knowledge, there are only five cases in the literature review. Therefore, it can be a diagnostic challenge for radiologists and clinicians because of rare incidence. PATIENT CONCERNS The patient visited our hospital due to melena and dizziness. DIAGNOSES The patient showed a huge ulcer and an exposed vessel in the posterior wall of the gastric high body during endoscopy. Angiography revealed a pseudoaneurysm of the splenic artery and contrast extravasation into the gastric lumen. INTERVENTIONS We performed coil embolization of splenic artery and gastrectomy. OUTCOMES Postprocedural course was uneventful and led to patient discharge on day 8. LESSONS We suggest that the splenic artery pseudoaneurysm should be considered differential diagnosis in the patients with acute upper gastrointestinal bleeding, and the presence of a splenic infarction may provide a diagnostic clue.
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Affiliation(s)
- Soo Buem Cho
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon
| | - Sung Eun Park
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon
| | | | | | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon
| | - Kyeong Hwa Ryu
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon
| | - Jin Il Moon
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon
| | - Bo Hwa Choi
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon
| | - Ji Young Ha
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon
| | - Sangmin Lee
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea
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93
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Santos FS, Sousa KMDS, de Castro TAC, Coelho F, de Oliveira RG, de Araujo WJB, Dos Santos LCP, de Souza RCA. Endovascular treatment of pseudoaneurysms secondary to chronic pancreatitis: reports of two cases. J Vasc Bras 2018; 17:71-75. [PMID: 29930685 PMCID: PMC5990257 DOI: 10.1590/1677-5449.012517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pseudoaneurysm secondary to chronic pancreatitis is a rare complication, but one with a high mortality rate. It is etiologically associated with chronic pancreatitis, and most diagnoses are made after rupture, which manifests with clinical signs of acute hemorrhage. Computed tomography plays an important role in diagnosis, but digital subtraction angiography remains the gold-standard method for diagnostic confirmation and for treatment planning. This article describes two cases of pseudoaneurysm in patients with chronic alcoholic pancreatitis; one involving the splenic artery and the other the gastroduodenal artery, complicated by thoracic and abdominal bleeding respectively. Both were successfully treated, using minimally invasive endovascular methods to implant coils and stent-grafts.
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Affiliation(s)
- Fabiana Seifert Santos
- Pontifícia Universidade Católica do Paraná - PUCPR, Curso de Medicina, Londrina, PR, Brasil
| | | | | | - Felipe Coelho
- Universidade de Brasília - UnB, Programa de Pós-graduação em Ciências Médicas, Brasília, DF, Brasil.,Pontifícia Universidade Católica do Paraná - PUCPR, Londrina, PR, Brasil
| | | | - Walter Jr Boim de Araujo
- Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Serviço de Angiorradiologia e Cirurgia Endovascular, Curitiba, PR, Brasil
| | | | - Raquel Canzi Almada de Souza
- Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Serviço de Endoscopia Digestiva, Departamento de Medicina Interna, Curitiba, PR, Brasil
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94
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Massive Hematemesis from a Splenic Artery Pseudoaneurysm Presenting Two Years after Penetrating Trauma. Case Rep Radiol 2018; 2018:7473168. [PMID: 29862112 PMCID: PMC5971296 DOI: 10.1155/2018/7473168] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/11/2018] [Indexed: 11/18/2022] Open
Abstract
Splenic artery pseudoaneurysms (PSA) are rare entities and far less common than true aneurysms of the splenic artery. The most common etiology is pancreatitis, recurrent either in the setting of chronic pancreatitis or as an episode of acute pancreatitis. Less common causes include trauma, peptic ulcer disease, or iatrogenic causes. Almost all of the trauma-related case reports have been due to blunt trauma. We believe this to be the first reported case of a splenic artery PSA presenting with massive hematemesis at a significant time frame after penetrating trauma. Successful transcatheter treatment was performed and alternative techniques are also discussed.
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95
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Abstract
OBJECTIVE Endovascular treatment (ET) is being increasingly used for splenic artery aneurysms (SAAs), but systematic treatment strategies have not been defined. We set out to investigate the optimal strategies for ET of complicated SAAs (CSAAs). METHODS CSAAs were classified into three types: type I, rupture or impending rupture; type II, at the origin of the splenic artery; and type III, having an aberrant splenic artery from the splenomesenteric trunk (type IIIA) or celiacomesenteric trunk (type IIIB). SAAs treated at our center during the last decade were reviewed, and CSAAs were selected for analysis. Patients' demographics, clinical manifestations, aneurysm characteristics, ET strategies, and outcomes were analyzed. RESULTS A total of 154 SAAs were identified, with 24 (15.6%) being CSAAs. Open surgery was employed in two patients, whereas 22 patients underwent ET. There were 3 patients with type I (type IIIA co-occurred in one of them), 5 with type II, and 15 with type III CSAAs. Treatment strategies included the following: immediate and thorough exclusion with embolization of the collaterals for type I; and dense embolization of the sac and outflow artery, with or without embolization of the inflow artery, or covered stent placement in the splenomesenteric trunk or celiacomesenteric, for types II and III. Technical success was achieved in 21 patients (95.5%). Mean follow-up was 33.7 ± 31.2 months (range, 1.5-117.0 months). The aneurysms remained completely thrombosed and unenlarged in 21 patients (95.5%). Reintervention was needed in one patient (4.5%) for persistent sac enlargement. The covered stent was asymptomatically occluded in one patient (11.1%). No hepatic or intestinal ischemia or death developed perioperatively or during the follow-up period. CONCLUSIONS With reasonable strategies toward the urgency and thoroughness needed for aneurysm exclusion as well as the anatomic challenges, ET appeared to be feasible, safe, and effective in the management of CSAAs.
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96
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Zabicki B, Limphaibool N, Holstad MJV, Juszkat R. Endovascular management of pancreatitis-related pseudoaneurysms: A review of techniques. PLoS One 2018; 13:e0191998. [PMID: 29377944 PMCID: PMC5788383 DOI: 10.1371/journal.pone.0191998] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 01/14/2018] [Indexed: 02/06/2023] Open
Abstract
Objectives To present the various techniques used in the management of pancreatitis-related pseudoaneurysms of visceral vessels. Methods The retrospective clinical study was carried out at the Department of Diagnostic and Interventional Radiology at Poznan University of Medical Sciences from 2011 to 2016. The fifteen patients included in the study were diagnosed with pseudoaneurysms of visceral arteries, as a complication of chronic pancreatitis. The diagnosis was made using contrast-enhanced computed tomography, followed by angiography. On admission, all patients were symptomatic, with varying degrees of abdominal pain. One patient was haemodynamically unstable. Treatments with endovascular techniques were analysed, along with their efficacy and outcomes. Coil embolisation was performed in 5 patients. Stent graft was used in 1 patient. Liquid embolic agents were used in 7 cases, of which 5 patients were treated with thrombin injection and 2 with Squid. A combination of techniques was used in 2 patients. Results The most common artery affected by pseudoaneurysm formation was the splenic artery (7/15; 46.7%), and the size of the pseudoaneurysms ranged from 27 mm to 85 mm. Primary technical success was achieved in 14 out of 15 patients (93.3%). One patient required reintervention. Two patients required splenectomy after embolisation due to splenic ischemia. No recanalisation was present at the follow-up computed tomography performed after 1 to 3 weeks, and no mortality was observed within 30 days. Conclusion Vascular complications of pancreatitis require accurate diagnosis and immediate treatment. Endovascular intervention is highly effective and is the preferred treatment option. The technique used is determined based on vascular anatomy and the patient’s haemodynamic status.
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Affiliation(s)
- Bartosz Zabicki
- Department of Diagnostic and Interventional Radiology, Poznan University of Medical Sciences, Poznan, Poland
- * E-mail:
| | - Nattakarn Limphaibool
- Department of Diagnostic and Interventional Radiology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Robert Juszkat
- Department of Diagnostic and Interventional Radiology, Poznan University of Medical Sciences, Poznan, Poland
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97
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Hewgley WP, Webb DL, Garrett HE. Migrated embolization coil causes intestinal obstruction. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2017; 4:8-11. [PMID: 29725660 PMCID: PMC5928003 DOI: 10.1016/j.jvscit.2017.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/01/2017] [Indexed: 01/17/2023]
Abstract
Visceral artery pseudoaneurysm is a rare, potentially fatal entity, but proper identification and management with coil embolization can lead to good outcomes. Embolization coils can migrate to various destinations, causing delayed complications in several case reports. A case of small bowel obstruction due to migrated embolization coils from a gastroduodenal pseudoaneurysm 6 years after initial treatment is presented.
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Affiliation(s)
- W Preston Hewgley
- Division of Vascular Surgery, University of Tennessee, Memphis, Tenn
| | - David L Webb
- Division of Vascular Surgery, University of Tennessee, Memphis, Tenn
| | - H Edward Garrett
- Division of Vascular Surgery, University of Tennessee, Memphis, Tenn
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98
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Song C, Dong J, Yu G, Zhou J, Xiang F, Pei Y, Lu Q, Jing Z. Comparison of open surgery and endovascular procedures as a therapeutic choice for visceral artery aneurysms. Vascular 2017; 26:387-392. [PMID: 29228875 DOI: 10.1177/1708538117744102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objectives Visceral arterial aneurysms may be treated using open surgery or endovascular repair, but the best approach remains controversial. This was a retrospective study aiming to compare open surgery and endovascular treatment strategies for visceral arterial aneurysms. Methods The study included all 93 patients who were admitted with visceral artery aneurysms between January 2001 and January 2011 at the Department of Vascular Surgery, Changhai Hospital, Shanghai, China. All cases underwent either open or endovascular procedures. Overall survival and adverse events were compared between the groups. Success rate, blood loss, length of surgery, and length of hospital stay were also compared. The patients were followed up at three, six, and 12 months then every year until April 2014. Results Open surgery was performed on 34 patients and endovascular procedures on 59. There were no differences in characteristics of the patients between the open surgery and endovascular groups. The perioperative complication rate was 52.9 and 13.6% in the open surgery and endovascular groups, respectively. Mean follow-up was 36.8 months (range: 11 months to 10 years). The one- and five-year survival rates were 100 and 60.6%, respectively, in the open surgery group, compared to 100 and 84.5% in the endovascular group. Multivariate analysis for factors related to overall survival showed that there was a significant relationship with the treatment approach (HR = 0.479, 95%CI: 0.278-0.825; P = 0.008) and the presence of false aneurysm (HR = 2.929, 95%CI: 1.388-6.180, P = 0.005). Conclusions Endovascular repair could be considered as an effective method for visceral artery aneurysm. Endovascular repair showed lower perioperative complication rates and better long-term survival.
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Affiliation(s)
- Chao Song
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Jian Dong
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Guanyu Yu
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Feng Xiang
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Yifei Pei
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China.,The first three authors contributed equally to this paper
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99
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Zavariz JD, Konstantatou E, Deganello A, Bosanac D, Huang DY, Sellars ME, Sidhu PS. Common and uncommon features of focal splenic lesions on contrast-enhanced ultrasound: a pictorial review. Radiol Bras 2017; 50:395-404. [PMID: 29307931 PMCID: PMC5746885 DOI: 10.1590/0100-3984.2015.0209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The characterization of focal splenic lesions by ultrasound can be quite
challenging. The recent introduction of contrast-enhanced ultrasound (CEUS) has
come to play a valuable role in the field of imaging splenic pathologies,
offering the possibility of an ionizing radiation-free investigation. Because
CEUS has been incorporated into everyday clinical practice, malignant diseases
such as focal lymphomatous infiltration, metastatic deposits, benign cysts,
traumatic fractures, and hemangiomas can now be accurately depicted and
characterized without the need for further imaging. More specifically, splenic
traumatic fractures do not require additional imaging by computed tomography
(with ionizing radiation exposure) for follow-up, because splenic fractures and
their complications are safely imaged with CEUS. In the new era of CEUS, more
patients benefit from radiation-free investigation of splenic pathologies with
high diagnostic accuracy.
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Affiliation(s)
- Julia D Zavariz
- MD, Department of Radiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | - Eleni Konstantatou
- MD, Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Annamaria Deganello
- MD, Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Diana Bosanac
- FRCR, Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Dean Y Huang
- FRCR, Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Maria E Sellars
- FRCR, Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
| | - Paul S Sidhu
- FRCR, Department of Radiology, King's College Hospital, Denmark Hill, London, United Kingdom
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100
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Guirgis M, Xu JH, Kaard A, Mwipatayi BP. Spontaneous Superior Mesenteric Artery Branch Pseudoaneurysm: A Rare Case Report. EJVES Short Rep 2017; 37:1-4. [PMID: 29234730 PMCID: PMC5651544 DOI: 10.1016/j.ejvssr.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 09/03/2017] [Accepted: 09/08/2017] [Indexed: 01/09/2023] Open
Abstract
Background Visceral arterial pseudoaneurysms (VAPAs) are rare vascular entities with serious consequences. Traditionally, they are associated with trauma, infection, and inflammatory disease, or they can arise as a post-operative complication. Report An 87 year old man presented with abdominal pain and was found to have a spontaneous VAPA on a computed tomography angiogram. Serial imaging 4 months previously had demonstrated no aneurysm. Between scans, warfarin was changed to apixaban for aortic valve replacement, but he had no other changes to any other medications. He required urgent endovascular coiling of the pseudoaneurysm, with satisfactory recovery and outcome. Discussion VAPAs are extremely rare, with splenic artery VAPAs the most commonly reported. Regardless, fewer than 250 cases of splenic artery pseudoaneurysm have been reported. Superior mesenteric artery (SMA) pseudoaneurysms are the rarest type of VAPAs. Early identification and urgent treatment are warranted because of the associated high mortality risk, with a 50% risk of rupture in any given VAPA. Treatment options range from open operation to endoscopic and endovascular procedures. Apixaban has been proposed to contribute to pseudoaneurysm formation by slow and continuous bleeding that results in the formation of the pseudoaneurysm. Conclusions Spontaneous VAPAs are extremely rare and this is the first time a VAPA has been associated with the novel oral anticoagulant "apixaban". Urgent management of any VAPAs is important because of the high risk of rupture and potential life threatening haemorrhage.
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Affiliation(s)
- Mina Guirgis
- Department of Vascular Surgery, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth, Australia
| | - Jema Hua Xu
- Department of Vascular Surgery, Hollywood Private Hospital, Monash Ave, Nedlands, Perth, Australia
| | - Alar Kaard
- Department of Radiology, Hollywood Private Hospital, Monash Ave, Nedlands, Perth, Australia
| | - Bibombe P Mwipatayi
- Department of Vascular Surgery, Royal Perth Hospital, Wellington St, Perth, Australia.,School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, Perth, Australia
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