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Uy PPD, Francisco DM, Trivedi A, O’Loughlin M, Wu GY. Vascular Diseases of the Spleen: A Review. J Clin Transl Hepatol 2017; 5:152-164. [PMID: 28660153 PMCID: PMC5472936 DOI: 10.14218/jcth.2016.00062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 02/15/2017] [Accepted: 02/23/2017] [Indexed: 12/12/2022] Open
Abstract
Vascular diseases of the spleen are relatively uncommon in the clinical practice. However, the reported incidence has been progressively increasing, probably due to advances in the imaging modalities used to detect them. This disease condition often presents with non-specific clinical manifestations, but can be associated with significant morbidity and mortality. This review article aims to provide updated clinical information on the different vascular diseases of the splenic vasculature-splenic vein thrombosis, splenic vein aneurysm, splenic artery aneurysm, splenic arteriovenous fistula, and spontaneous splenorenal shunt-in order to aid clinicians in early diagnosis and management.
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Affiliation(s)
- Pearl Princess D. Uy
- Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA
- Department of Gastroenterology & Hepatology, University of Connecticut Health Center, Farmington, CT, USA
- *Correspondence to: Pearl Princess D. Uy, Department of Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-1235, USA. Tel: +1-860-810-9608, Fax: +1-860-679-4613, E-mail:
| | | | - Anshu Trivedi
- Department of Pathology, Hartford Hospital, Hartford, CT, USA
| | | | - George Y. Wu
- Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA
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102
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Jauhari A, Shrivastava A, Soni RK, Darbari A. Pseudo Aneurysm of Aberrant Right Gastroepiploic Artery Mimicking Pseudocyst of Pancreas- A Rare Case Report. J Clin Diagn Res 2017; 11:PD09-PD10. [PMID: 28571209 DOI: 10.7860/jcdr/2017/25314.9651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/20/2017] [Indexed: 11/24/2022]
Abstract
Pseudoaneurysm of peripancreatic vessel is a rare complication of pancreatitis. The splenic artery is the most commonly affected vessels close to the pancreas. Pseudoaneurysm of right gastroepiploic artery is rare. It can rupture into Gastro Intestinal (GI) tract, retroperitoneum, peritoneal cavity, biliopancreatic duct or pseudocyst. Clinical diagnosis of unruptured pseudoaneurysm is rarely possible because there are no specific signs and symptoms. We hereby report a case of pseudoaneurysm of aberrant right gastroepiploic artery in 30-year-old male which presented with history of epigastric pain and lump with episode of haematemesis and malena. Diagnosis was suspected on Doppler Ultrasonography (USG), which was later confirmed by CECT and angiography. Patient was treated by coil embolization. The pain and lump in epigastrium disappeared within five to six days. Patient is symptom free after six months of follow up.
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Affiliation(s)
- Abhinav Jauhari
- Senior Resident, Department of Surgery, V.M.M.C. and Safdarjung Hospital, New Delhi, India
| | - Ambuj Shrivastava
- Postgraduate Student, Department of Radio diagnosis, Sri Devarajurs Medical College, Kolar, Karnataka, India
| | - Rajesh Kumar Soni
- Professor, Department of Surgery, V.M.M.C. and Safdarjung Hospital, New Delhi, India
| | - Ashutosh Darbari
- Associate Professor, Department of Surgery, Chirayu Medical College, Bhopal, Madhya Pradesh, India
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103
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De Silva WSL, Gamlaksha DS, Jayasekara DP, Rajamanthri SD. A splenic artery aneurysm presenting with multiple episodes of upper gastrointestinal bleeding: a case report. J Med Case Rep 2017; 11:123. [PMID: 28468689 PMCID: PMC5415772 DOI: 10.1186/s13256-017-1282-7] [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: 01/06/2017] [Accepted: 03/31/2017] [Indexed: 12/13/2022] Open
Abstract
Background Splenic artery aneurysm is rare and its diagnosis is challenging due to the nonspecific nature of the clinical presentation. We report a case of a splenic artery aneurysm in which the patient presented with chronic dyspepsia and multiple episodes of minor intragastric bleeding. Case presentation A 60-year-old, previously healthy Sri Lankan man presented with four episodes of hematemesis and severe dyspeptic symptoms over a period of 6 months. The results of two initial upper gastrointestinal endoscopies and an abdominal ultrasound scan were unremarkable. A third upper gastrointestinal endoscopy detected a pulsatile bulge at the posterior wall of the gastric antrum. A contrast-enhanced computed tomogram of his abdomen detected a splenic artery aneurysm measuring 3 × 3 × 2.5 cm. While awaiting routine surgery, he developed a torrential upper gastrointestinal bleeding and shock, leading to emergency laparotomy. Splenectomy and en bloc resection of the aneurysm with the posterior stomach wall were performed. Histology revealed evidence for a true aneurysm without overt, acute, or chronic inflammation of the surrounding gastric mucosa. He became completely asymptomatic 2 weeks after the surgery. Conclusions Splenic artery aneurysms can result in recurrent upper gastrointestinal bleeding. The possibility of impending catastrophic bleeding should be remembered when managing patients with splenic artery aneurysms after a minor bleeding. Negative endoscopy and ultrasonography should require contrast-enhanced computed tomography to look for the cause of recurrent upper gastrointestinal bleeding.
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Affiliation(s)
- W S L De Silva
- Post Graduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - D S Gamlaksha
- Post Graduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | - D P Jayasekara
- Vascular and Transplant Surgical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - S D Rajamanthri
- Vascular and Transplant Surgical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
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104
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Jayakumar L, Caputo FJ, Lombardi JV. Endovascular Repair of a Splenic Artery Aneurysm With Anomalous Origin From the Superior Mesenteric Artery. Vasc Endovascular Surg 2017; 51:152-154. [DOI: 10.1177/1538574417690344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A 22 year old female with a history of recurrent abdominal pain was transferred to our institution with a diagnosis of splenic artery aneurysm identified on imaging. CT angiography of the abdomen and pelvis revealed a partially thrombosed 3.0 cm splenic artery aneurysm without signs of rupture and with an anomalous origin from the superior mesenteric artery. The patient was successfully treated with endovascular exclusion of the aneurysm. Herein we review some of the nuances of endovascular repair of splenic artery aneurysm.
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Affiliation(s)
- Lalithapriya Jayakumar
- Division of Vascular Surgery, Department of Surgery, Cooper Medical School of Rowan University, NJ, USA
| | - Francis J. Caputo
- Division of Vascular Surgery, Department of Surgery, Cooper Medical School of Rowan University, NJ, USA
| | - Joseph V. Lombardi
- Division of Vascular Surgery, Department of Surgery, Cooper Medical School of Rowan University, NJ, USA
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Abstract
In the last decade, higher rates of nonoperative management of liver, spleen, and kidney injuries have been achieved. An algorithmic approach may improve success on a national level. Factors for success include management strategy based on physiologic status of the child, early attempt at resuscitation using blood products, and appropriate use of adjuncts. Shorter hospitalizations are appropriate for children who have not bled significantly, and discharge instructions facilitate the safety of early discharge. Although routine imaging is not required for liver or spleen injury, symptoms should prompt reevaluation. Reimaging of renal injuries remains in common use.
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106
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Repin IG, Savostiyanov KA, Mizin SP, Stolyarov AA, Repin DI. [Acute bleeding from upper gastrointestinal tract due to splenic artery pseudoaneurysm in a cavity of pancreatic pseudocyst]. Khirurgiia (Mosk) 2017:87-90. [PMID: 28514389 DOI: 10.17116/hirurgia2017587-90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- I G Repin
- Chair of Surgery with the course of endoscopy, Central State Medical Academy of the Presidential Administration of the Russian Federation
| | | | - S P Mizin
- Chair of Surgery with the course of endoscopy, Central State Medical Academy of the Presidential Administration of the Russian Federation
| | - A A Stolyarov
- City Clinical Hospital #51 of the Moscow City Health Department
| | - D I Repin
- Chair of Surgery with the course of endoscopy, Central State Medical Academy of the Presidential Administration of the Russian Federation
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107
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Komarov RN, Vinogradov OA, Puzanov AI, Dzyundzya AN, Gagarina NV. Surgical treatment of patients with visceral arteries aneurysms. ACTA ACUST UNITED AC 2017. [DOI: 10.17116/kardio201710376-81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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108
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Budimir I, Jurčić P, Nikolić M, Ljubičić N. Upper gastrointestinal bleeding caused by fistula of the stomach and splenic artery pseudoaneurysm. Br J Hosp Med (Lond) 2016; 77:721. [PMID: 27937019 DOI: 10.12968/hmed.2016.77.12.721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- I Budimir
- Consultant Gastroenterologist and Hepatologist, Department of Gastroenterology and Hepatology, Clinic of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - P Jurčić
- Medical Oncology Trainee, Department of Radiotherapy and Medical Oncology, University Hospital for Tumours, Sestre milosrdnice University Hospital Centre, 10000, Zagreb, Croatia
| | - M Nikolić
- Consultant Gastroenterologist and Hepatologist, Division of Gastroenterology, Department of Internal Medicine, Sestre milosrdnice Clinical Hospital Centre, University of Zagreb School of Medicine and School of Dental Medicine, Zagreb, Croatia
| | - N Ljubičić
- Professor of Medicine and Consultant Gastroenterologist and Hepatologist, Division of Gastroenterology, Department of Internal Medicine, Sestre milosrdnice Clinical Hospital Centre, University of Zagreb School of Medicine and School of Dental Medicine, Zagreb, Croatia
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109
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110
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Haematochezia from a Splenic Artery Pseudoaneurysm Communicating with Transverse Colon: A Case Report and Literature Review. Case Rep Vasc Med 2016; 2016:8461501. [PMID: 27559488 PMCID: PMC4983343 DOI: 10.1155/2016/8461501] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 06/22/2016] [Indexed: 12/28/2022] Open
Abstract
Splenic artery aneurysms (SAA) are the third most common intra-abdominal aneurysm. Complications include invasion into surrounding structures often in association with preexisting pancreatic disease. We describe an 88-year-old female, with no history of pancreatic disease, referred with lower gastrointestinal bleeding. CT angiography showed a splenic artery pseudoaneurysm with associated collection and fistula to the transverse colon at the level of the splenic flexure. The pseudoaneurysm was embolised endovascularly with metallic microcoils. Rectal bleeding ceased. The patient recovered well and follow-up angiography revealed no persistence of the splenic artery pseudoaneurysm. SAA rupture results in 29%–50% mortality. Experienced centres report success with the endovascular approach in haemodynamically unstable patients, as a bridge to surgery, and even on a background of pancreatic disease. This case highlights the importance of prompt CT angiography, if endoscopy fails to identify a cause of gastrointestinal bleeding. Endovascular embolisation provides a safe and effective alternative to surgery, where anatomical considerations and local expertise permit.
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111
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Guo B, Guo D, Xu X, Chen B, Shi Z, Luo J, Jiang J, Fu W. Early and intermediate results of endovascular treatment of symptomatic and asymptomatic visceral artery aneurysms. J Vasc Surg 2016; 64:140-8. [DOI: 10.1016/j.jvs.2016.02.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 02/09/2016] [Indexed: 10/22/2022]
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112
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Rebonato A, Maiettini D, Krokidis M, Graziosi L, Rossi M. Late Migration of a Covered Stent into the Stomach after Repair of a Splenic Artery Pseudoaneurysm. J Radiol Case Rep 2016; 10:26-32. [PMID: 27200159 DOI: 10.3941/jrcr.v10i2.2620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We would like to report our experience of a rather rare complication that occurred in a 76-year old patient tree years after endovascular repair of a splenic artery pseudoaneurysm with a covered stent. Three years after stent insertion, the patient complained of mild abdominal pain and melena; it was revealed endoscopically that the covered stent has eroded the stomach wall and migrated into the stomach. The splenic artery is the most common location among the spectrum of potential presentation sites of visceral arteries aneurysms and pseudoaneurysms. Endovascular treatment with the use of coils or stents is the first option due to lower morbidity and mortality than open surgery. Endovascular repair may also lead to complications and patients need to be followed up in order to confirm aneurysm sealing, and exclude late complication. Minor stent graft migration may occur in the long term, however extra vascular migration is extremely rare.
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Affiliation(s)
- Alberto Rebonato
- Department of Surgical and Biomedical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Daniele Maiettini
- Department of Surgical and Biomedical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Miltiadis Krokidis
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Luigina Graziosi
- Department of Surgical and Biomedical Sciences, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Michele Rossi
- Radiology Department, St. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
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113
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Srinivasan PH, Vithon GE, Dhati KNM, Rajendran VR. Sinister Splenic Artery Pseudoaneursym: A Rare Case of Unidentified Aetiology. J Clin Diagn Res 2016; 10:PD01-3. [PMID: 27190881 DOI: 10.7860/jcdr/2016/16833.7536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/09/2016] [Indexed: 11/24/2022]
Abstract
Splenic Artery Pseudoaneurysms (SAP) are very rare. Giant SAPs are those which are more than 5 cm in diameter and are rarer. SAPs are usually caused by pancreatitis, trauma, surgery or other iatrogenic interventions, vasculitis, local infective or inflammatory processes. We report the successful surgical management of a giant SAP of unidentified aetiology. This case report highlights the significance that this entity may present atypically and hence, early recognition and aggressive management may be life saving.
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Affiliation(s)
| | - Gopi Ellikunnel Vithon
- Professor, Department of General Surgery, Government Medical College , Kozhikode, Kerala, India
| | | | - Vadukkoot Raman Rajendran
- Professor and Head, Department of Radiodiagnosis, Government Medical College , Kozhikode, Kerala, India
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114
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Değer KC, Gündeş E, Fedakar A. Surgical management of a splenic artery aneurysm. Clin Case Rep 2016; 4:524-5. [PMID: 27190621 PMCID: PMC4856251 DOI: 10.1002/ccr3.550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/26/2016] [Accepted: 03/09/2016] [Indexed: 11/15/2022] Open
Abstract
Aneurisms of the splenic artery are rare clinical findings. Surgeons and interventional radiologists should co‐operate in the management of this challenging disease; we describe here a surgical option.
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Affiliation(s)
- Kamuran Cumhur Değer
- Gastroenterological Surgery Department Kartal Koşuyolu High Speciality and Training Hospital Istanbul Turkey
| | - Ebubekir Gündeş
- Gastroenterological Surgery Department Kartal Koşuyolu High Speciality and Training Hospital Istanbul Turkey
| | - Ali Fedakar
- Cardiovascular Surgery Department Kartal Koşuyolu High Speciality and Training Hospital Istanbul Turkey
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115
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Prevalence and predictive factors for development of splenic artery aneurysms in cirrhosis. Indian J Gastroenterol 2016; 35:201-6. [PMID: 27256433 DOI: 10.1007/s12664-016-0670-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/10/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Splenic artery aneurysm (SAA) rarely occurs in the general population. Its increased incidence has been reported in cirrhosis. The aim of this retrospective study was to identify prevalence and predictive factor development of SAA in patients with cirrhosis. METHODS All patients with cirrhosis who were treated in our clinics between 2010 and 2014 were included in the study. Demographic features and clinical and laboratory findings were reviewed. Four-phase computerized tomography (CT) was used for identifying SAA. Imaging was reviewed for the presence of SAA as well as hepatic artery, portal vein, splenic artery, splenic vein, liver parenchyma, and intraabdominal cavity were evaluated. RESULTS A total of 171 patients (age 55±13.9, 109 men) were included in the study. There was SAA in 27 (15.7 %) patients. Mean diameter of aneurysm was 11.66 (range, 6.06-27.1) mm. Aneurysm was located in the distal part of splenic artery in 20 (74 %) patients and solitary in 24 (88.8 %), and asymptomatic in all patients. Patients with SAA had larger portal vein and splenic vein compared to patients without SAA (15.3±3.9 vs. 13.1±2.9 mm, p=0.001; and 12.5±4.4 vs. 9.6±2.7 mm, p<0.001, respectively). We identified positive correlation between development of SAA and splenic vein diameter [hazard ratio (HR) =1.23; 95 % confidence interval (CI) 0.97-1.57; p = 0.009] and negative correlation between hepatic artery diameter and development of SAA HR = 0.46; 95 % CI 0.25-0.85; p = 0.002). CONCLUSION SAA occurred in a significant proportion of patients with cirrhosis, and enlargement of the splenic vein seemed to be a predictive factor for the development of SAA.
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116
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Trauma associated splenic artery aneurysms: an analysis of the National Trauma Data Bank. Am J Surg 2016; 211:739-43. [DOI: 10.1016/j.amjsurg.2015.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 11/12/2015] [Accepted: 11/23/2015] [Indexed: 12/18/2022]
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117
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Abstract
Imaging plays a major role in the evaluation of patients who present to the emergency department with acute left upper quadrant (LUQ) pain. Multidetector computed tomography is currently the primary modality used for imaging these patients. The peritoneal reflections, subperitoneal compartment, and peritoneal spaces of the LUQ are key anatomic features in understanding the imaging appearance of acute diseases in this area. Diseases of the stomach, spleen, pancreas, and splenic flexure are encountered in patients with acute LUQ pain. Optimization of the imaging protocol is vital for accurate diagnosis and characterization of these diseases in the acute setting.
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Affiliation(s)
- Jacob S Ecanow
- Department of Radiology, NorthShore University HealthSystem, 2650 Ridge Avenue, Suite G507, Evanston, IL 60201, USA
| | - Richard M Gore
- Department of Radiology, NorthShore University HealthSystem, 2650 Ridge Avenue, Suite G507, Evanston, IL 60201, USA.
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118
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Soder BL, Dart BW, Stanley JD. Appendicitis—Current Practices in a Tertiary Referral Center. Am Surg 2016. [DOI: 10.1177/000313481608200204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Brent L. Soder
- Department of Surgery University of Tennessee College of Medicine Chattanooga Chattanooga, Tennessee
| | - Benjamin W. Dart
- Department of Surgery University of Tennessee College of Medicine Chattanooga Chattanooga, Tennessee
| | - J. Daniel Stanley
- Department of Surgery University of Tennessee College of Medicine Chattanooga Chattanooga, Tennessee
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119
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Teoh ZH, Surya A, Mathialahan T, Khan H. An insidious case of hepatic artery pseudoaneurysm secondary to acalculus cholecystitis. BMJ Case Rep 2015; 2015:bcr-2015-212424. [PMID: 26561228 DOI: 10.1136/bcr-2015-212424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 68-year-old man with expressive dysphasia presented with upper gastrointestinal haemorrhage, jaundice and abdominal pain. He was unable to tolerate ultrasound tranducer pressure. His oesophagogastroduodenoscopy (OGD) showed large blood clots in the stomach with blood trickling from the ampulla. An urgent CT angiogram demonstrated a 32 mm pseudoaneurysm within the gallbladder fossa. The patient subsequently underwent an endovascular embolisation of the pseudoaneurysm performed by the interventional radiology team.
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Affiliation(s)
- Z H Teoh
- Department of Gastroenterology, Wrexham Maelor Hospital, Wrexham, UK
| | - A Surya
- Department of Gastroenterology, Wrexham Maelor Hospital, Wrexham, UK
| | - T Mathialahan
- Department of Gastroenterology, Wrexham Maelor Hospital, Wrexham, UK
| | - H Khan
- Department of Gastroenterology, Wrexham Maelor Hospital, Wrexham, UK
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120
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Naganuma M, Matsui H, Koizumi J, Fushimi K, Yasunaga H. Short-term outcomes following elective transcatheter arterial embolization for splenic artery aneurysms: data from a nationwide administrative database. Acta Radiol Open 2015; 4:2047981615574354. [PMID: 26443101 PMCID: PMC4580119 DOI: 10.1177/2047981615574354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 02/01/2015] [Indexed: 12/14/2022] Open
Abstract
Background Splenic artery aneurysm (SAA) rupture is life-threatening. Although elective transcatheter arterial embolization (TAE) suggested low in-hospital death in previous studies, there has been no large multi-center study of elective TAE for SAA. Purpose To examine the short-term outcomes of TAE for splenic artery aneurysm (SAA) and analyze the factors associated with the outcomes, including liver cirrhosis, using a nationwide administrative inpatient database. Material and Methods We identified patients who received elective TAE with a principal diagnosis of SAA. We assessed the patient background characteristics, comprising age, sex, and specific co-morbidities, including liver cirrhosis. The outcomes included the rate of TAE-related complications (acute pancreatitis, splenic infarction, splenic abscess, or intraperitoneal hematoma), length of stay, and in-hospital mortality. Results Among 18.3 million inpatients in the database between July 2010 and March 2013, we identified 534 patients who received elective TAE for SAA at 229 participating hospitals. Fifty-four (10.1%) patients had liver cirrhosis. No in-hospital deaths were observed. Thirty-two (6.0%) patients had at least one TAE-related complication. A multivariate linear regression analysis revealed that liver cirrhosis was significantly associated with longer length of stay (9.5 days; 95% confidence interval [CI], 7.0–12.0 days; P < 0.001). A logistic regression analysis showed that liver cirrhosis was not significantly associated with TAE-related complications (odds ratio, 0.99; 95% CI, 0.29–3.39; P = 0.980). Conclusion The results revealed no in-hospital mortality and a low complication rate associated with elective TAE for SAA including liver cirrhosis patients.
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Affiliation(s)
- Michio Naganuma
- Department of Radiology, Shonan Izumi Hospital, Kanagawa, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Jun Koizumi
- Department of Diagnostic Radiology, School of Medicine, Tokai University, Kanagawa, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Sawicki M, Marlicz W, Czapla N, Łokaj M, Skoczylas MM, Donotek M, Kołaczyk K. Massive Upper Gastrointestinal Bleeding from a Splenic Artery Pseudoaneurysm Caused by a Penetrating Gastric Ulcer: Case Report and Review of Literature. Pol J Radiol 2015; 80:384-7. [PMID: 26309450 PMCID: PMC4538884 DOI: 10.12659/pjr.894465] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 06/02/2015] [Indexed: 12/12/2022] Open
Abstract
Background Splenic artery aneurysm and pseudoaneurysm are rare pathologies. True aneurysms are usually asymptomatic. Aneurysm rupture occurring in 2–3% of cases results in bleeding into the lesser sack, peritoneal space or adjacent organs typically presenting as abdominal pain and hemodynamic instability. In contrast, pseudoaneurysms are nearly always symptomatic carrying a high risk of rupture of 37–47% and mortality rate of 90% if untreated. Therefore, prompt diagnosis and treatment are essential in the management of patients with splenic artery pseudoaneurysm. Typical causes include pancreatitis and trauma. Rarely, the rupture of a pseudoaneurysm presents as upper gastrointestinal (UGI) bleeding. Among causes, peptic ulcer is the casuistic one. Case Report This report describes a very rare case of recurrent UGI bleeding from a splenic artery pseudoaneurysm caused by a penetrating gastric ulcer. After negative results of endoscopy and ultrasound, the diagnosis was established in CT angiography. The successful treatment consisted of surgical ligation of the bleeding vessel and suture of the ulcer with preservation of the spleen and pancreas, which is rarely tried in such situations. Conclusions The most important factor in identifying a ruptured splenic artery pseudoaneurysm as a source of GI bleeding is considering the diagnosis. UGI hemorrhage from splenic artery pseudoaneurysm can have a relapsing course providing false negative results of endoscopy and ultrasound if performed between episodes of active bleeding. In such cases, immediate CT angiography is useful in establishing diagnosis and in application of proper therapy before possible recurrence.
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Affiliation(s)
- Marcin Sawicki
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Norbert Czapla
- Clinic of Plastic, Endocrine and General Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Marek Łokaj
- Clinic of Plastic, Endocrine and General Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Michał M Skoczylas
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
| | - Maciej Donotek
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Kołaczyk
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
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Casey P, Kausar A, Gavan D, Wilde N. Ultrasound-guided percutaneous thrombin for the management of superior mesenteric artery pseudoaneurysm. J Vasc Surg Cases 2015; 1:211-213. [PMID: 31724605 PMCID: PMC6849914 DOI: 10.1016/j.jvsc.2015.06.001] [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: 04/22/2015] [Accepted: 06/24/2015] [Indexed: 11/23/2022] Open
Abstract
Visceral aneurysms are a well-recognized and potentially fatal occurrence in the event of rupture. Endovascular occlusion using stent grafting or embolization is often favorable over high-risk open surgical repair. However, interventional mesenteric angiography may not always be feasible or successful. We present an emergency case of successful occlusion of a large peripancreatic pseudoaneurysm using a single percutaneous injection of thrombin under ultrasound guidance alone after both laparotomy and mesenteric angiography had failed to identify and control bleeding. In this case and review of the current evidence, we propose an effective alternative first-line treatment strategy in these complex patients.
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Affiliation(s)
- Patrick Casey
- Department of Surgery, East Lancashire Hospital NHS Trusts, Blackburn, United Kingdom
| | - Ambareen Kausar
- Department of Surgery, East Lancashire Hospital NHS Trusts, Blackburn, United Kingdom
| | - Duncan Gavan
- Department of Radiology, East Lancashire Hospital NHS Trusts, Blackburn, United Kingdom
| | - Neil Wilde
- Department of Radiology, East Lancashire Hospital NHS Trusts, Blackburn, United Kingdom
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123
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Splenic Pseudoaneursym as the Cause of Recurrent Gastrointestinal Bleeding in a Woman With Diffuse Scleroderma. ACG Case Rep J 2015; 2:98-100. [PMID: 26157926 PMCID: PMC4435363 DOI: 10.14309/crj.2015.17] [Citation(s) in RCA: 2] [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: 08/20/2014] [Accepted: 12/10/2014] [Indexed: 11/17/2022] Open
Abstract
A 67-year-old woman with a 15-year history of intestinal scleroderma presented with recurrent melena. Upper endoscopies revealed a healing, non-bleeding, large gastric ulcer. After the third bleed, angiography demonstrated bleeding from a splenic artery pseudoaneurysm adjacent to the gastric ulcer. Scleroderma patients are at risk of bleeding from esophagitis or gastric arteriovenous malformations, while splenic artery pseudoaneurysms are primarily attributed to pancreatitis and trauma. This is the first reported case of gastrointestinal bleeding from a splenic artery pseudoaneurysm in a patient with intestinal scleroderma and a large gastric ulcer.
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124
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Lachhab I, Benkabbou A, Souadka A, El Malki HO, Mohsine R, Ifrine L, Belkouchi A. [Splenic artery aneurysm ruptured in the stomach: surgery after failed attempt of embolization]. Pan Afr Med J 2015; 20:66. [PMID: 26090024 PMCID: PMC4450033 DOI: 10.11604/pamj.2015.20.66.3667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/05/2015] [Indexed: 11/12/2022] Open
Abstract
L'anévrisme de l'artère splénique (AAS) est une entité pathologique rare le plus souvent asymptomatique. Nous rapportons le cas d'un patient âgé de 60 ans, hypertendu qui s'est présenté aux urgences pour un épisode d'hématémèse sans retentissement hémodynamique. Un bilan complet comportant un Angioscanner abdominal a mis en évidence un anévrisme de l'artère splénique refoulant la paroi postérieure de l'estomac en avant. Le diagnostic d'anévrisme de l'artère splénique rompu dans l'estomac a été posé et un traitement endovasculaire à type d'embolisation par coils effectué. Au 5ème jour post embolisation, le patient nous a été référé pour une persistance de mélénas. Un traitement chirurgical a été décidé. La mise à plat de l'anévrisme a permis d’évacuer les coils et le thrombus. L'objectif de cette observation est de montrer que l'embolisation d'un AAS rompu dans l'estomac a été une cause de retard thérapeutique qui pourrait être fatal pour le patient. Le traitement de référence est la cure chirurgicale de l'AAS par voie conventionnelle sans rétablissement de la continuité artérielle splénique, sans splénectomie et avec suture de l'orifice digestif.
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Affiliation(s)
- Imad Lachhab
- Service de Chirurgie Générale A, Hôpital Ibn Sina-CHU Rabat, Faculté de Médecine et de Pharmacie Mohamed V, Rabat, Maroc
| | - Amine Benkabbou
- Service de Chirurgie Générale A, Hôpital Ibn Sina-CHU Rabat, Faculté de Médecine et de Pharmacie Mohamed V, Rabat, Maroc
| | - Amine Souadka
- Service de Chirurgie Générale A, Hôpital Ibn Sina-CHU Rabat, Faculté de Médecine et de Pharmacie Mohamed V, Rabat, Maroc
| | - Haj Omar El Malki
- Service de Chirurgie Générale A, Hôpital Ibn Sina-CHU Rabat, Faculté de Médecine et de Pharmacie Mohamed V, Rabat, Maroc
| | - Raouf Mohsine
- Service de Chirurgie Générale A, Hôpital Ibn Sina-CHU Rabat, Faculté de Médecine et de Pharmacie Mohamed V, Rabat, Maroc
| | - Lahcen Ifrine
- Service de Chirurgie Générale A, Hôpital Ibn Sina-CHU Rabat, Faculté de Médecine et de Pharmacie Mohamed V, Rabat, Maroc
| | - Abdelkader Belkouchi
- Service de Chirurgie Générale A, Hôpital Ibn Sina-CHU Rabat, Faculté de Médecine et de Pharmacie Mohamed V, Rabat, Maroc
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125
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Chia C, Pandya GJ, Kamalesh A, Shelat VG. Splenic Artery Pseudoaneurysm Masquerading as a Pancreatic Cyst-A Diagnostic Challenge. Int Surg 2015; 100:1069-71. [PMID: 26414829 PMCID: PMC4587508 DOI: 10.9738/intsurg-d-14-00149.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Splenic artery pseudoaneurysm is a rare entity. Clinical diagnosis is challenging because presentation is often varied. It can range from an incidental finding to hemodynamic collapse from sudden rupture and bleeding. The most common cause of this condition is pancreatitis. We report an unusual case of a young man not known to have pancreatitis who presented with hematemesis with normal esophagogastroduodenoscopy. Imaging modalities did not lead to a definitive diagnosis, and he underwent emergency laparotomy with surgical ligation of splenic artery pseudoaneurysm for hemodynamic instability, without a definitive preoperative diagnosis.
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Affiliation(s)
- C Chia
- 1 Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - G J Pandya
- 2 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - A Kamalesh
- 2 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - V G Shelat
- 1 Department of General Surgery, Tan Tock Seng Hospital, Singapore
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126
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Mahmoud MZ, Al-Saadi M, Abuderman A, Alzimami KS, Alkhorayef M, Almagli B, Sulieman A. "To-and-fro" waveform in the diagnosis of arterial pseudoaneurysms. World J Radiol 2015; 7:89-99. [PMID: 26029351 PMCID: PMC4444605 DOI: 10.4329/wjr.v7.i5.89] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/31/2014] [Accepted: 04/07/2015] [Indexed: 02/06/2023] Open
Abstract
Medical ultrasound imaging with Doppler plays an essential role in the diagnosis of vascular disease. This study intended to review the clinical use of “to-and-fro” waveform at duplex Doppler ultrasonography (DDU) in the diagnosis of pseudoaneurysms in the arterial vessels of upper and lower extremities, abdominal aorta, carotid and vertebral arteries as well as to review our personal experiences of “to-and-fro” waveform at DDU also. After receiving institutional review board approval, an inclusive literature review was carried out in order to review the scientific foundation of “to-and-fro” waveform at DDU and its clinical use in the diagnosis of pseudoaneurysms in various arterial vessels. Articles published in the English language between 2000 and 2013 were evaluated in this review study. Pseudoaneurysms in arterial vessels of the upper and lower extremities, abdominal aorta, carotid and vertebral arteries characterized by an extraluminal pattern of blood flow, which shows variable echogenicity, interval complexity, and “to-and-fro” flow pattern on color Doppler ultrasonography. In these arterial vessels, Duplex ultrasonography can demonstrate the degree of clotting, pseudoaneurysm communication, the blood flow patterns and velocities. Spectral Doppler applied to pseudoaneurysms lumen revealed systolic and diastolic turbulent blood flow with traditional “to-and-fro” waveform in the communicating channel. Accurate diagnosis of pseudoaneurysm by spectral Doppler is based on the documentation of the “to-and-fro” waveform. The size of pseudoaneurysm determines the appropriate treatment approach as surgical or conservative.
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127
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Tiwari C, Sandlas G, Jayaswal S, Shah H. WITHDRAWN: Idiopathic Pancreatitis with Splenic Artery Pseudoaneurysm in a Child: A Rare Presentation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Schatz RA, Schabel S, Rockey DC. Idiopathic Splenic Artery Pseudoaneurysm Rupture as an Uncommon Cause of Hemorrhagic Shock. J Investig Med High Impact Case Rep 2015; 3:2324709615577816. [PMID: 26425639 PMCID: PMC4528868 DOI: 10.1177/2324709615577816] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Splenic artery pseudoaneurysms are infrequently encountered but critical to recognize. Limited literature to date describes associations with pancreatitis, trauma, and rarely peptic ulcer disease. Hemorrhage and abdominal pain are the most common manifestations. There is typically overt gastrointestinal blood loss but bleeding can also extend into the peritoneum, retroperitoneum, adjacent organs, or even a pseudocyst. Most patients with ruptured splenic artery pseudoaneurysms present with hemodynamic instability. Here, we describe a patient recovering from acute illness in the intensive care unit but with otherwise no obvious risk factors or precipitants for visceral pseudoaneurysm. He presented with acute onset altered mental status, nausea, and worsening back and abdominal pain and was found to be in hypovolemic shock. The patient was urgently stabilized until more detailed imaging could be performed, which ultimately revealed the source of blood loss and explained his rapid decompensation. He was successfully treated with arterial coiling and embolization. Thus, we herein emphasize the importance of prompt recognition of hemorrhagic shock and of aggressive hemodynamic stabilization, as well as a focused diagnostic approach to this problem with specific treatment for splenic artery pseudoaneurysm. Finally, we recommend that multidisciplinary management should be the standard approach in all patients with splenic artery pseudoaneurysm.
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Affiliation(s)
- Richard A Schatz
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Stephen Schabel
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Don C Rockey
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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129
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Duan XH, Ren JZ, Zhou GF, Zheng CS, Liang HM, Dong XJ, Feng GS. Clinical Features and Endovascular Treatment of Visceral Artery Pseudoaneurysms. Ann Vasc Surg 2015; 29:482-90. [DOI: 10.1016/j.avsg.2014.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 10/27/2014] [Accepted: 11/06/2014] [Indexed: 10/24/2022]
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130
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Abstract
Arterial pseudoaneurysm formation of visceral arteries as a vascular complication of pancreatitis, either acute or chronic, is an uncommon phenomenon. This review article discusses the incidence, pathophysiology, imaging, treatment strategies, and prognosis of mesenteric pseudoaneurysms complicating pancreatitis.
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131
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Dohan A, Dautry R, Guerrache Y, Fargeaudou Y, Boudiaf M, Le Dref O, Sirol M, Soyer P. Three-dimensional MDCT angiography of splanchnic arteries: Pearls and pitfalls. Diagn Interv Imaging 2015; 96:187-200. [DOI: 10.1016/j.diii.2014.06.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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132
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Shuaib W, Tiwana MH, Vijayasarathi A, Sadiq MF, Anderson S, Amin N, Khosa F. Imaging of vascular pseudoaneurysms in the thorax and abdomen. Clin Imaging 2015; 39:352-62. [PMID: 25682302 DOI: 10.1016/j.clinimag.2015.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 12/27/2014] [Accepted: 01/14/2015] [Indexed: 12/17/2022]
Abstract
INTRODUCTION This review article illustrates a spectrum of arterial pseudoaneurysms that may occur in various locations throughout the thoracoabdominal region. This article discusses the common etiologies and typical clinical presentations of arterial pseudoaneurysms as well as the imaging modalities employed in their diagnosis and potential treatment options. OBJECTIVE The goal of this review article is to familiarize radiologists with the diagnosis of thoracoabdominal arterial pseudoaneurysms, the prompt identification and treatment of which are crucial in this patient population. CONCLUSION In summary, a thorough understanding of the etiologies, imaging characteristics, and clinical implications of pseudoaneurysms can help optimize identification and management of this spectrum of disease.
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Affiliation(s)
- Waqas Shuaib
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA.
| | | | - Arvind Vijayasarathi
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA
| | | | - Stephen Anderson
- Department of Radiology, Boston University School of Medicine, Boston, MA
| | - Neil Amin
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA
| | - Faisal Khosa
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA
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133
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Ierardi AM, Petrillo M, Capasso R, Fontana F, Bacuzzi A, Duka E, Laganà D, Carrafiello G. Urgent endovascular ligature of a ruptured splenic artery pseudoaneurysm in a patient with acute pancreatitis: a case report. J Med Case Rep 2015; 9:6. [PMID: 25575735 PMCID: PMC4326335 DOI: 10.1186/1752-1947-9-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 11/25/2014] [Indexed: 11/30/2022] Open
Abstract
Introduction We report on the successful endovascular treatment of a ruptured splenic artery pseudoaneurysm. Our patient had acute pancreatitis superimposed on chronic calcific pancreatitis and chronic renal impairment. Contrast-enhanced ultrasonography was used to assess post-embolization results. Case presentation Our patient was a 67-year-old white Caucasian man with recurrent pancreatitis. Computed tomography angiography showed a pancreatic pseudocyst with a ruptured pseudoaneurysm, which was successfully embolized using an endovascular percutaneous approach. At six months, persistent renal failure led to contrast-enhanced ultrasonography. This confirmed the absence of turbulent blood flow and extravasation of contrast medium in the pseudocyst. Conclusion Our experience with this case leads us to support the role of interventional radiology as a first-line treatment tool. Contrast-enhanced ultrasonography can be used to follow-up embolization procedures in patients with impaired renal function.
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Affiliation(s)
| | | | | | | | | | | | | | - Gianpaolo Carrafiello
- Department of Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri 57, 21100 Varese, VA, Italy.
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134
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135
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Choudhary N, Puri R, Sud R. An uncommon pancreatic mass lesion is leading to recurrent gastrointestinal bleed. Endosc Ultrasound 2014; 3:252-3. [PMID: 25485275 PMCID: PMC4247535 DOI: 10.4103/2303-9027.144549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 02/07/2014] [Indexed: 11/04/2022] Open
Affiliation(s)
- Narendra Choudhary
- Institute of digestive and hepatobiliary sciences, Medanta The Medicity, Gurgaon, India
| | - Rajesh Puri
- Institute of digestive and hepatobiliary sciences, Medanta The Medicity, Gurgaon, India
| | - Randhir Sud
- Institute of digestive and hepatobiliary sciences, Medanta The Medicity, Gurgaon, India
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136
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Takasugi S, Kaminou T, Ohuchi Y, Yata S, Adachi A, Kawai T, Endo M, Ogawa T. Coil Embolization with Side-Holed Catheter to Preserve Peripheral Flow for Visceral Artery Pseudoaneurysm: An Experimental Study in Swine. J Vasc Interv Radiol 2014; 25:1867-72. [DOI: 10.1016/j.jvir.2014.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/07/2014] [Accepted: 06/08/2014] [Indexed: 11/28/2022] Open
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137
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Syed SM, Moradian S, Ahmed M, Ahmed U, Shaheen S, Stalin V. A benign gastric ulcer eroding into a splenic artery pseudoaneurysm presenting as a massive upper gastrointestinal bleed. J Surg Case Rep 2014; 2014:rju102. [PMID: 25413998 PMCID: PMC4239299 DOI: 10.1093/jscr/rju102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Upper gastrointestinal (UGI) bleeding secondary to a ruptured splenic artery (SA) pseudoaneurysm into the stomach is a rare but a life-threatening condition. Owing to the low prevalence, it remains a diagnostic and therapeutic challenge. A frail 77-year-old Caucasian female presented with epigastric pain and hematemesis. Endoscopy was non-diagnostic for an etiology. She then underwent diagnostic angiography that revealed an SA pseudoaneurysm with active contrast extravasation into the stomach. Subsequent transcatheter arterial coil embolization was conducted of the SA. The patient was subsequently taken for a partial gastrectomy, distal pancreatectomy and splenectomy. She had an uncomplicated postoperative course. Diagnosis of an UGI bleeding secondary to a ruptured SA pseudoaneurysm into the stomach remains difficult. However, we report that in a hemodynamically stable patient, a multidisciplinary approach can be taken, with interval optimization of the patient prior to definitive surgery for a satisfactory outcome.
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Affiliation(s)
- Shareef M Syed
- Department of General Surgery, Central Michigan University, Saginaw, MI, USA
| | | | - Mohammed Ahmed
- Department of General Surgery, Northwestern University, Chicago, IL, USA
| | - Umair Ahmed
- School of Medicine, American University of Antigua, New York, NY, USA
| | - Samuel Shaheen
- Department of General Surgery, Vice Chair of Surgical Disciplines, Central Michigan University, Saginaw, MI, USA
| | - Vasanth Stalin
- Department of General Surgery, Central Michigan University, Saginaw, MI, USA
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138
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Dohan A, Eveno C, Dautry R, Guerrache Y, Camus M, Boudiaf M, Gayat E, Le Dref O, Sirol M, Soyer P. Role and Effectiveness of Percutaneous Arterial Embolization in Hemodynamically Unstable Patients with Ruptured Splanchnic Artery Pseudoaneurysms. Cardiovasc Intervent Radiol 2014; 38:862-70. [DOI: 10.1007/s00270-014-1002-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 08/25/2014] [Indexed: 12/21/2022]
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139
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Liu B, Zhou L, Liu M, Xie X. Giant peripancreatic artery aneurysm with emphasis on contrast-enhanced ultrasound: report of two cases. J Med Ultrason (2001) 2014; 42:103-8. [PMID: 26578497 DOI: 10.1007/s10396-014-0572-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 08/01/2014] [Indexed: 12/30/2022]
Abstract
Visceral artery aneurysms have a potential possibility of rupture with life-threatening hemorrhage, and prompt detection and optimal treatment are required clinically. Actually, abdominal ultrasound plays a major role in detection of visceral artery aneurysms. Besides, the administration of contrast agents can highly improve the characterization of the lesion. Herein, we present two cases of giant peripancreatic artery aneurysm with emphasis on contrast-enhanced ultrasound (CEUS). Case 1 was a 54-year-old asymptomatic man who was diagnosed with a 12.1 cm × 5.2 cm splenic artery aneurysm in the absence of a clear etiologic factor. Case 2 was a 37-year-old man with a 6.3 cm × 5.3 cm pancreaticoduodenal artery pseudoaneurysm associated with chronic pancreatitis. Both diagnoses were confirmed by contrast-enhanced computer tomography (CECT) and digital subtracted angiography (DSA). Transcatheter embolization occlusion using coiling was successfully performed for both cases. Postoperative computed tomography angiography (CTA) showed complete occlusion. It is suggested that CEUS seems to be a promising diagnostic option and contributes to preoperative treatment planning for patients with peripancreatic artery aneurysm.
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Affiliation(s)
- Baoxian Liu
- Department of Medical Ultrasonics, Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, 58 Zhong Shan Road 2, 510080, Guangzhou, China
| | - Luyao Zhou
- Department of Medical Ultrasonics, Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, 58 Zhong Shan Road 2, 510080, Guangzhou, China
| | - Ming Liu
- Department of Medical Ultrasonics, Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, 58 Zhong Shan Road 2, 510080, Guangzhou, China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Division of Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, 58 Zhong Shan Road 2, 510080, Guangzhou, China.
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140
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Alabousi A, Patlas MN, Scaglione M, Romano L, Soto JA. Cross-Sectional Imaging of Nontraumatic Emergencies of the Spleen. Curr Probl Diagn Radiol 2014; 43:254-67. [DOI: 10.1067/j.cpradiol.2014.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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141
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Mohanty S, Mukhopadhyay S, Yusuf J, Tyagi S. Emergency hepatic artery embolization in a patient with post-traumatic ruptured hepatic artery pseudoaneurysm. J Emerg Trauma Shock 2014; 7:246-7. [PMID: 25114441 PMCID: PMC4126131 DOI: 10.4103/0974-2700.136878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Subhendu Mohanty
- Department of Cardiology, GB Pant Hospital and Associated Maulana Azad Medical College, Delhi, India. E-mail:
| | - Saibal Mukhopadhyay
- Department of Cardiology, GB Pant Hospital and Associated Maulana Azad Medical College, Delhi, India. E-mail:
| | - Jamal Yusuf
- Department of Cardiology, GB Pant Hospital and Associated Maulana Azad Medical College, Delhi, India. E-mail:
| | - Sanjay Tyagi
- Department of Cardiology, GB Pant Hospital and Associated Maulana Azad Medical College, Delhi, India. E-mail:
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142
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Kukliński A, Batycki K, Matuszewski W, Ostrach A, Kupis Z, Lęgowik T. Embolization of a large, symptomatic splenic artery pseudoaneurysm. Pol J Radiol 2014; 79:194-8. [PMID: 25009678 PMCID: PMC4089775 DOI: 10.12659/pjr.889974] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 01/31/2014] [Indexed: 01/30/2023] Open
Abstract
Background Splenic artery aneurysm is the third most common abdominal aneurysm. Most often it is due to pancreatitis. There were only 19 cases of aneurysms larger than 5 cm in diameter described in the literature. Management of splenic artery aneurysms depends on the size and symptoms. Invasive treatment modalities involve open procedures and interventional radiology methods (endovascular). Case Reports A 44-years-old male with chronic pancreatitis, in a gradually worsening general condition due to a large splenic artery aneurysm, was subjected to the procedure. Blood flow through the aneurysm was cut-off by implanting a covered stent between celiac trunk and common hepatic artery. Patient’s general condition rapidly improved, allowing discharge home in good state soon after the procedure. Conclusions Percutaneous embolization appears to be the best method of treatment of large splenic artery aneurysms. Complications of such treatment are significantly less dangerous than those associated with surgery.
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Affiliation(s)
- Adam Kukliński
- Department of Surgery, Radom Specialist Hospital, Radom, Poland
| | - Krzysztof Batycki
- Department of Diagnostic Imaging, Radom Specialist Hospital, Radom, Poland
| | | | - Andrzej Ostrach
- Department of Surgery, Radom Specialist Hospital, Radom, Poland
| | - Zbigniew Kupis
- Department of Surgery, Radom Specialist Hospital, Radom, Poland
| | - Tomasz Lęgowik
- Department of Diagnostic Imaging, Radom Specialist Hospital, Radom, Poland
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143
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Han YM, Lee JY, Choi IJ, Kim CG, Cho SJ, Lee JH, Kim HB, Choi JM. Endoscopic removal of a migrated coil after embolization of a splenic pseudoaneurysm: a case report. Clin Endosc 2014; 47:183-7. [PMID: 24765602 PMCID: PMC3994262 DOI: 10.5946/ce.2014.47.2.183] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/17/2013] [Accepted: 07/08/2013] [Indexed: 12/26/2022] Open
Abstract
Splenic artery pseudoaneurysms can be caused by pancreatitis, trauma, or operation. Traditionally, the condition has been managed through surgery; however, nowadays, transcatheter arterial embolization is performed safely and effectively. Nevertheless, several complications of pseudoaneurysm embolization have been reported, including coil migration. Herein, we report a case of migration of the coil into the jejunal lumen after transcatheter arterial embolization of a splenic artery pseudoaneurysm. The migrated coil was successfully removed by performing endoscopic intervention.
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Affiliation(s)
- Yoo Min Han
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Yeul Lee
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Il Ju Choi
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Chan Gyoo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Soo-Jeong Cho
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Jun Ho Lee
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Hyun Beom Kim
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Ji Min Choi
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Splenic artery pseudoaneurysm presenting as massive hematemesis: a diagnostic dilemma. Case Rep Surg 2014; 2014:501937. [PMID: 24716077 PMCID: PMC3971889 DOI: 10.1155/2014/501937] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 01/08/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction. Splenic artery Pseudoaneurysm, a complication of chronic pancreatitis, presenting as massive hematemesis is a rare presentation. Case Report. We present a case of 38-year-old male admitted with chief complaints of pain in the upper abdomen and massive hematemesis for the last 15 days. On examination there was severe pallor. On investigating the patient, Hb was 4.0 gm/dL, upper GI endoscopy revealed a leiomyoma in fundus of stomach, and EUS Doppler also supported the UGI findings. On further investigation of the patient, CECT of the abdomen revealed a possibility of distal pancreatic carcinoma encasing splenic vessels and infiltrating the adjacent structure. FNA taken at the time of EUS was consistent with inflammatory pathology. Triple phase CT of the abdomen revealed a splenic artery pseudoaneurysm with multiple splenic infarcts. After resuscitation we planned an emergency laparotomy; splenic artery pseudoaneurysm densely adherent to adjacent structures and associated with distal pancreatic necrosis was found. We performed splenectomy with repair of the defect in the stomach wall and necrosectomy. Postoperative course was uneventful and patient was discharged on day 8. Conclusion. Pseudoaneurysm can be at times a very difficult situation to manage; options available are either catheter embolisation if patient is vitally stable, or otherwise, exploration.
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146
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Lau YZ, Lau YF, Lai KY, Lau CP. Splenic artery pseudoaneurysm due to seatbelt injury in a glucose-6-phosphate dehydrogenase-deficient adult. Singapore Med J 2013; 54:e230-2. [PMID: 24276111 DOI: 10.11622/smedj.2013189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 23-year-old man presented with abdominal pain after suffering blunt trauma caused by a seatbelt injury. His low platelet count of 137 × 10(9)/L was initially attributed to trauma and his underlying hypersplenism due to glucose-6-phosphate dehydrogenase (G6PD) deficiency. Despite conservative management, his platelet count remained persistently reduced even after his haemoglobin and clotting abnormalities were stabilised. After a week, follow-up imaging revealed an incidental finding of a pseudoaneurysm (measuring 9 mm × 8 mm × 10 mm) adjacent to a splenic laceration. The pseudoaneurysm was successfully closed via transcatheter glue embolisation; 20% of the spleen was also embolised. A week later, the platelet count normalised, and the patient was subsequently discharged. This case highlights the pitfalls in the detection of a delayed occurrence of splenic artery pseudoaneurysm after blunt injury via routine delayed phase computed tomography. While splenomegaly in G6PD may be a predisposing factor for injury, a low platelet count should arouse suspicion of internal haemorrhage rather than hypersplenism.
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Affiliation(s)
- Yu Zhen Lau
- Cardiac Heart Health Centre, Suite 1303, Central Building, 3 Pedder Street, Central, Hong Kong, China.
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147
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[Dynamic tumor in the right liver lobe]. Chirurg 2013; 85:537-40. [PMID: 23949736 DOI: 10.1007/s00104-013-2578-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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148
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Abstract
INTRODUCTION Splenic artery aneurysm is more frequently diagnosed today with the advancement and liberal use of imaging modalities. A symptomatic aneurysm, an aneurysm of any diameter in a pregnant woman or a woman of childbearing age, and an aneurysm >2 cm are all strong indications for surgery because of a significantly increased risk for splenic artery rupture. CASE DESCRIPTION A 35-year-old, morbidly obese, African American woman presented with constant left flank pain for 4 weeks. Angiography confirmed a 2.5-cm splenic artery aneurysm near the splenic hilum. Because angioembolization was unlikely to succeed because of extensive collaterals and the aneurysm's proximity to the splenic hilum, laparoscopic excision of the aneurysm with splenectomy was performed. DISCUSSION We report the successful laparoscopic surgical treatment of a 2.5-cm splenic artery aneurysm. Any splenic artery aneurysm with a significantly increased risk of rupture requires a prompt intervention. Although percutaneous embolization of the splenic artery is the most frequently applied therapy today, surgical repair is preferred for all symptomatic aneurysms because of the greater likelihood of success.
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Affiliation(s)
- Youngjin Kim
- Department of General Surgery, Arrowhead Regional Medical Center, Fontana, CA 92335, USA.
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149
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Ohira S, Kimura T, Takeuchi K, Matsushita T, Masuda S, Shimizu Y. Pancreaticoduodenal artery aneurysm involving papilla of vater successfully treated with endovascular approach despite intraoperative rupture. Ann Vasc Surg 2013; 27:802.e9-802.e12. [PMID: 23711966 DOI: 10.1016/j.avsg.2012.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 06/05/2012] [Accepted: 06/21/2012] [Indexed: 11/30/2022]
Abstract
An 81-year-old woman presented with dizziness and nasal bleeding. Gastrointestinal fiberscopy (GIF) showed a pulsatile aneurysm in the duodenum, and that the orifice of the papilla of Vater was involved. Three-dimensional computed tomography imaging showed an unruptured aneurysm in the pancreatic duodenal arcade. The patient underwent an emergent endovascular embolization of the donor arteries using coils and gelatin sponge particles. She was discharged without any complications. This case was extremely rare because of the anatomic location of the unruptured pancreaticoduodenal artery aneurysm and the fact that it involved the papilla of Vater, was detected with GIF, and was successfully treated endovascularly.
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Affiliation(s)
- Suguru Ohira
- Department of Cardiovascular Surgery, Maizuru Mutual Hospital, Kyoto, Japan.
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150
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Ho MF, Chan YC, Cheng SW. Successful endovascular management of giant splenic artery aneurysms. Vascular 2013; 21:317-22. [PMID: 23493275 DOI: 10.1177/1708538113478744] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2012] [Indexed: 11/16/2022]
Abstract
Giant pseudoaneurysms of the splenic artery, with a diameter of 5 cm or more, are rare surgical emergencies, and conventional open surgery usually involves splenectomy. The aim of this study is to report two cases from our institution and to review the world's literature on successful endovascular treatment of patients with giant splenic artery pseudoaneurysms. A retrospective review of a prospectively entered departmental computerized database was performed for the two patients from our institution. Articles were searched electronically from PubMed and Medline, using the terms 'giant splenic artery', 'endovascular' and 'embolization'; and relevant cases were reviewed from the world's literature. We hereby report two patients with giant splenic artery pseudoaneurysms who were treated successfully with endovascular procedures. In addition to the two patients from our institution, there were five patients with giant splenic artery pseudoaneurysms in the published literature who underwent successful endovascular management. The first patient of our series had the largest pseudoaneursym size of 7.2 × 8.1 cm, which is the largest documented pseudoaneursym in the current literature. We report two cases of giant splenic artery pseudoaneurysm with one being the largest pseudoaneurysm treated with endovascular technique in the current literature. Endovascular coil embolization of main trunk of splenic artery is less invasive than open surgical treatment for giant splenic artery pseudoaneurysm, and circumvents the problem of difficult exposure, especially in those patients with significant co-morbidity.
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Affiliation(s)
- M F Ho
- Department of Surgery, Division of Vascular & Endovascular Surgery, University of Hong Kong Medical Centre, South Wing, 14th Floor K Block, Queen Mary Hospital, Hong Kong
| | - Y C Chan
- Department of Surgery, Division of Vascular & Endovascular Surgery, University of Hong Kong Medical Centre, South Wing, 14th Floor K Block, Queen Mary Hospital, Hong Kong
| | - S W Cheng
- Department of Surgery, Division of Vascular & Endovascular Surgery, University of Hong Kong Medical Centre, South Wing, 14th Floor K Block, Queen Mary Hospital, Hong Kong
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