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Vincenzi P, Gaudenzi D, Mulazzani L, Rebonato A, Patriti A. Crohn's Disease and Jejunal Artery Aneurysms: A Report of the First Case and a Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1344. [PMID: 36295505 PMCID: PMC9611918 DOI: 10.3390/medicina58101344] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/01/2022] [Accepted: 09/21/2022] [Indexed: 12/01/2023]
Abstract
Background and Objectives: Jejunal artery (JA) and ileal artery (IA) aneurysms constitute less than 3% of all visceral artery aneurysms (VAAs), carrying a risk of rupture as high as 30%, and a mortality of 20%. Though many etiologies have been reported in the literature, no mention exists on a causal association between these aneurysms and inflammatory bowel diseases (IBD). We present the first case of a JA aneurysm related to Crohn's Disease (CD) together with a review of the literature. Materials and Methods: A 74-year-old male presenting with CD intestinal relapse and an incidental finding at the computed tomography enterography (CTE) of a 53 × 47 × 25mm apparently intact JA pseudoaneurysm, arising from the first and second jejunal branches, underwent coil embolization followed by small bowel resection, with an uneventful outcome. We also included the review of literature on JA and IA aneurysms, analyzing all reports published in PubMed and Scopus from 1943 to July 2022. Results: 60 manuscripts with 103 cases of JA and IA aneurysms in 100 patients were identified. Among cases with available data, 34 (33.0%) presented acutely with rupture, 45 (43.7%) were described as non-ruptured. 83 (80.6%), and 14 (13.6%) were JA and IA aneurysms, respectively, having a median size of 15 (range:3.5-52) mm. Atherosclerosis (16.5%), infections (10.7%), and vasculitides/connective tissue disorders (9.7%) represented the main causes mentioned. Mean age was 53.6 (±19.2) years, male patients being 59.4%. One third of patients (32.4%) were asymptomatic. Overall, treatment was indicated in 63% of patients, with surgery and endovascular procedures performed in 61.9% and 38.1% cases, respectively. The technical success rate of endovascular treatment (EVT) was 95.8%. The mortality rate was 11.8%, being higher (21.2%) in the rupture group. Conclusions: The prompt treatment accomplished in our case granted a successful outcome. JA and IA aneurysms should be included among local complications of IBD. Considering their high potential for rupture, regardless of size, a low threshold for endovascular or surgical treatment should be applied.
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Affiliation(s)
- Paolo Vincenzi
- Department of Surgery, Ospedali Riuniti Marche Nord, Piazzale Cinelli n 1, 61121 Pesaro, Italy
| | - Diletta Gaudenzi
- Department of Perioperative Services, AOU Ospedali Riuniti di Ancona, Via Conca n 71, 60126 Ancona, Italy
| | - Luca Mulazzani
- Department of Radiology, Division of Interventional Radiology, Ospedali Riuniti Marche Nord, Piazzale Cinelli n 1, 61121 Pesaro, Italy
| | - Alberto Rebonato
- Department of Radiology, Division of Interventional Radiology, Ospedali Riuniti Marche Nord, Piazzale Cinelli n 1, 61121 Pesaro, Italy
| | - Alberto Patriti
- Department of Surgery, Ospedali Riuniti Marche Nord, Piazzale Cinelli n 1, 61121 Pesaro, Italy
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Costa S, Costa A, Pereira T, Maciel J. Ruptured jejunal artery aneurysm. BMJ Case Rep 2013; 2013:bcr-2013-008772. [PMID: 23771962 DOI: 10.1136/bcr-2013-008772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Visceral artery aneurysms (VAAs), unlike aortic aneurysms, are very rare, but are also a potentially lethal vascular disease. Jejunal artery aneurysms only account for less than 3% of VAAs, but have a 30% risk of rupture, with 20% death rate, presenting with only few and vague symptoms. We report the case of a 76-year-old man presenting at the emergency department (ED) with a crampy epigastric pain and vomiting. An ultrasound performed diagnosed free abdominal fluid and immediate CT scan diagnosed jejunal artery aneurysm spontaneously rupturing, followed by hypovolaemic shock. Emergent surgery was undertaken, and aneurysmectomy, followed by partial enterectomy with primary anastomosis were performed, because of segmentary jejunal ischaemia. The patient's recovery was unremarkable. High level of suspicion, rapid diagnosis capability and prompt surgical or endovascular intervention, as well as an effective teamwork in the ED are critical to avoid the devastating consequences of ruptured VAAs.
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Affiliation(s)
- Sílvia Costa
- Department of Surgery, Centro Hospitalar Gaia/Espinho, EPE, Gaia, Portugal.
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3
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Olsen AB, Ralhan T, Harris JH, Evani V. Superior mesenteric artery pseudoaneurysm after blunt abdominal trauma. Ann Vasc Surg 2013; 27:674-8. [PMID: 23522700 DOI: 10.1016/j.avsg.2012.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 08/25/2012] [Accepted: 09/24/2012] [Indexed: 11/28/2022]
Abstract
True aneurysms and pseudoaneurysms of the visceral arteries are uncommon. Visceral artery aneurysms (VAAs) represent 0.1-0.2% of all vascular aneurysms and were also found in 0.1% of autopsies. VAAs most commonly affect the splenic (60%), hepatic (20%), and superior mesenteric (9%) arteries. Mesenteric injury caused by blunt abdominal trauma is relatively rare. A 30-year-old man arrived at our trauma hospital and was found to have a traumatic pseudoaneurysm of the superior mesenteric artery (SMA) after a motor vehicle collision. To date, only 10 visceral arterial pseudoaneurysms have been reported in the literature. We present an 11th case of a pseudoaneurysm involving the SMA after blunt abdominal trauma.
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Affiliation(s)
- Alex Bryan Olsen
- Department of General Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA.
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4
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Endovascular embolization of a third jejunal artery aneurysm: Isolation technique using the amplatzer vascular plug 4. Catheter Cardiovasc Interv 2012; 81:1049-52. [DOI: 10.1002/ccd.24415] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Accepted: 03/09/2012] [Indexed: 11/07/2022]
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Palmucci S, Mauro LA, Milone P, Di Stefano F, Scolaro A, Di Cataldo A, Ettorre GC. Diagnosis of ruptured superior mesenteric artery aneurysm mimicking a pancreatic mass. World J Gastroenterol 2010; 16:2298-301. [PMID: 20458769 PMCID: PMC2868225 DOI: 10.3748/wjg.v16.i18.2298] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aneurysms and pseudoaneurysms of the superior mesenteric artery are potentially lethal and should be treated as urgently as possible. In a 52-year-old man with occasional epigastric pain, we accidentally discovered a superior mesenteric artery aneurysm that was ruptured with spontaneous tamponade in the uncinate process and in the head of the pancreas. The ruptured aneurysm had a heterogeneous appearance due to its thrombotic and hemorrhagic content, and it simulated a voluminous mass in the head and uncinate process of the pancreas, associated with mild dilatation of the main pancreatic duct. Recent advances in multidetector computed tomography and magnetic resonance imaging have enabled radiologists to develop a correct diagnosis of mesenteric aneurysms and pseudoaneurysms of the visceral branches of the abdominal aorta, and to differentiate this diagnosis from that of pancreatic or peripancreatic masses; angiography is currently used to confirm a diagnosis and to develop therapeutic treatments.
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6
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Asano M, Nushida H, Nagasaki Y, Tatsuno Y, Ueno Y. Rupture of a jejunal artery aneurysm. Leg Med (Tokyo) 2008; 10:268-73. [PMID: 18378483 DOI: 10.1016/j.legalmed.2008.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Revised: 02/13/2008] [Accepted: 02/15/2008] [Indexed: 10/22/2022]
Abstract
Aneurysm of the superior mesenteric artery or its branches is rare. We herein present a case of a ruptured aneurysm of the jejunal artery, a branch of the superior mesenteric artery, and we also review 19 cases of jejunal artery aneurysm reported in the English literature. A 66-year-old male who had received a fist blow to the face presented in the emergency ward of his local hospital. His physical examination was unremarkable and he went back home after treatment of his facial wound. Two hours later he again visited the hospital, this time for severe abdominal pain, and he was hospitalized for suspicion of an intraperitoneal hemorrhage. Selective arteriography of the superior mesenteric artery revealed a ruptured aneurysm in the first branch of the jejunal artery. An emergency laparotomy was performed, but the patient died 29h after the injury. Because there was no evidence of any trauma to the abdomen, we concluded that the cause of death was exsanguination due to a ruptured aneurysm, and was not directly related to the earlier trauma. This case is considered to be of medico-legal interest regarding whether the rupture resulted from a natural disease or was due to an assault.
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Affiliation(s)
- Migiwa Asano
- Department of Legal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
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7
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Gandini R, Pipitone V, Konda D, Pendenza G, Spinelli A, Stefanini M, Simonetti G. Endovascular treatment of a giant superior mesenteric artery pseudoaneurysm using a nitinol stent-graft. Cardiovasc Intervent Radiol 2005; 28:102-6. [PMID: 15772727 DOI: 10.1007/s00270-004-0007-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
A 68-year-old woman presenting with gastrointestinal bleeding (hematocrit 19.3%) and in a critical clinical condition (American Society of Anesthesiologists grade 4) from a giant superior mesenteric artery pseudoaneurysm (196.0 x 131.4 mm) underwent emergency endovascular treatment. The arterial tear supplying the pseudoaneurysm was excluded using a 5.0 mm diameter and 31 mm long monorail expanded polytetrafluoroethylene (ePTFE)-covered self-expanding nitinol stent. Within 6 days of the procedure, a gradual increase in hemoglobin levels and a prompt improvement in the clinical condition were observed. Multislice CT angiograms performed immediately, 5 days, 30 days and 3 months after the procedure confirmed the complete exclusion of the pseudoaneurysm.
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Affiliation(s)
- Roberto Gandini
- Diagnostic Imaging and Interventional Radiology, University of Tor Vergata, Rome, Italy
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8
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Iribarren-Marín MA, González-García A, Simó-Muerza G, Echenagusia-Belda A. Seudoaneurisma de la arteria mesentérica superior tras pancreatitis aguda. Embolización mediante microcoils. RADIOLOGIA 2001. [DOI: 10.1016/s0033-8338(01)76981-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Rundback JH, Chughtai S, Rozenblit G, Panageas E, Poplausky M. Traumatic ileocolic pseudoaneurysm: diagnosis and transcatheter treatment. Catheter Cardiovasc Interv 1999; 48:217-9. [PMID: 10506785 DOI: 10.1002/(sici)1522-726x(199910)48:2<217::aid-ccd22>3.0.co;2-j] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Injuries to branches of the superior mesenteric artery are unusual and often difficult to diagnose, yet require prompt recognition and treatment to prevent exsanguinating hemorrhage or bowel ischemia. This report describes a unique case of an ileocolic artery pseudoaneurysm diagnosed using delayed CT imaging and definitively treated by transcatheter embolization. Cathet. Cardiovasc. Intervent. 48:217-219, 1999.
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Affiliation(s)
- J H Rundback
- Department of Radiology, New York Medical College, Westchester Medical Center, Valhalla, New York 10595, USA.
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10
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Tan BS, Reidy JF. Case report: Transcatheter embolization of a superior mesenteric artery pseudoaneurysm with interlocking detachable coils. Clin Radiol 1998; 53:455-7. [PMID: 9651064 DOI: 10.1016/s0009-9260(98)80277-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- B S Tan
- Department of Diagnostic Radiology, Guy's Hospital, London, UK
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11
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Carr SC, Pearce WH, Vogelzang RL, McCarthy WJ, Nemcek AA, Yao JS. Current management of visceral artery aneurysms. Surgery 1996; 120:627-33; discussion 633-4. [PMID: 8862370 DOI: 10.1016/s0039-6060(96)80009-2] [Citation(s) in RCA: 201] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Visceral artery aneurysms are an uncommon but important form of abdominal vascular disease. This study reviews a contemporary experience with special emphasis on newer methods of diagnosis and treatment. METHODS From 1980 to 1994, 37 patients were diagnosed with 46 visceral artery aneurysms. These consisted of 22 splenic, 10 hepatic, 4 superior mesenteric, 2 gastroduodenal, 3 celiac, 2 left gastric, 1 pancreatoduodenal, 1 jejunal-ileal, and 1 inferior mesenteric artery aneurysms. Follow-up was complete for 28 patients, average of 37.7 months. There were 17 asymptomatic and 29 symptomatic aneurysms, including 11 presenting with rupture. RESULTS Seventeen patients were treated surgically, with no surgical deaths. Surgical complications included splenic abscess (two) and failure to thrombose (one). Transcatheter embolization was used in 12 patients. Complications included splenic infarction (one) and recurrence (two), successfully treated with repeat embolization. Nine patients were treated with observation. Eight experienced no complications during follow-up; one died of a ruptured splenic artery aneurysm before treatment was initiated. CONCLUSIONS The widespread use of computed tomography has led to increased detection of asymptomatic visceral artery aneurysms. Although surgery remains necessary in many patients, transcatheter embolization is effective in the treatment of selected visceral artery aneurysms with few complications and low recurrence.
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Affiliation(s)
- S C Carr
- Department of Surgery, Northwestern University Medical School, Chicago, III, USA
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12
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Røkke O, Søndenaa K, Amundsen S, Bjerke-Larssen T, Jensen D. The diagnosis and management of splanchnic artery aneurysms. Scand J Gastroenterol 1996; 31:737-43. [PMID: 8858739 DOI: 10.3109/00365529609010344] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- O Røkke
- Dept. of Surgery, Haukeland Hospital University of Bergen, Norway
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13
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Uher P, Nyman U, Ivancev K, Lindh M. Aneurysms of the pancreaticoduodenal artery associated with occlusion of the celiac artery. ABDOMINAL IMAGING 1995; 20:470-3. [PMID: 7580788 DOI: 10.1007/bf01213275] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Aneurysms of the pancreaticoduodenal artery are rare and may be associated with celiac artery stenosis or occlusion. Twenty-eight patients are reported in the literature. The diagnostic findings and therapeutic alternatives of four additional patients form the basis of this report. One patient with ruptured pancreaticoduodenal aneurysm was successfully treated by transcatheter embolization, and one patient was treated surgically; both patients had an uneventful recovery. In the remaining two patients, the aneurysms were left untreated. One patient died 1 year later of an unrelated cause, and the other patient is symptom-free after 2 years.
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Affiliation(s)
- P Uher
- Department of Diagnostic Radiology, Malmö General Hospital, University of Lund, Sweden
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14
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Abstract
Middle colic artery aneurysms are very uncommon. A few cases of occlusion of superior mesenteric artery aneurysms without bowel ischemia are reported. We describe successful uncomplicated embolization of a ruptured middle colic artery aneurysm with a Gelfoam plug.
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Affiliation(s)
- A Naito
- Department of Radiology, Chuden Hospital, Hiroshima City, Japan
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Repasky RG, Tisnado J, Freedman AM. Transcatheter embolization of a superior mesenteric artery pseudoaneurysm and arteriovenous fistula. J Vasc Interv Radiol 1993; 4:241-4. [PMID: 8481571 DOI: 10.1016/s1051-0443(93)71844-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- R G Repasky
- Department of Radiology, Medical College of Virginia Hospitals, Richmond 23298-0615
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