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Sebai A, Elaifia R, Atri S, Hammami Y, Haddad A, Kacem JM. Surgical management of a proximal splenic artery aneurysm: A case report. Int J Surg Case Rep 2024; 117:109499. [PMID: 38492317 PMCID: PMC10958614 DOI: 10.1016/j.ijscr.2024.109499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 03/18/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Splenic artery aneurysms (SAA's) pose a rare yet clinically significant challenge, characterized by the weakening and ballooning of the splenic artery, potentially leading to severe complications such as rupture and hemorrhage. CASE PRESENTATION A 52-year-old female presenting with biliary colic. Diagnostic imaging revealed a saccular lesion closely associated with gallstones. A multidisciplinary approach guided the decision for surgery due to the size and location of the aneurysm. A bi sub costal laparotomy was performed, after the resection of the aneurysm, an arterial anastomosis with pds 5/0 suture was performed. CLINICAL DISCUSSION SAA's treatment modalities are tailored based on aneurysm localization and size. Imaging modalities such as Doppler ultrasound and CT angiography play a crucial role in accurate diagnosis, providing essential information for treatment planning. Treatment options include endovascular embolization, and surgical intervention. Traditionally open surgical techniques, including ligation of the splenic artery, aneurysmectomy, and splenectomy. Surgical treatment, especially for proximal aneurysms, is highlighted, with the presented alternative approach of resection with end-to-end anastomosis, showcasing an alternative surgical technique aimed at reducing the risk of spleen infarction. CONCLUSION SAA's are a rarity that emphasizes the need for early detection and intervention. We are urged to maintain a high index of suspicion, particularly in high-risk individuals. We report an alternative surgical technique that we hope will contributes to the expanding repertoire of approaches, calling for further research to optimize SAA management strategies in the quest for improved patient outcomes.
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Affiliation(s)
- A Sebai
- Department of Surgery A La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - R Elaifia
- Department of Surgery A La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - S Atri
- Department of Surgery A La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Y Hammami
- Department of Surgery A La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - A Haddad
- Department of Surgery A La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - J M Kacem
- Department of Surgery A La Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
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Njoum Y, Barqawi AD, Maree M. Spontaneous rupture of a splenic artery aneurysm causing acute abdomen in a 19-year-old male patient: a case report. Front Surg 2023; 10:1223271. [PMID: 37790992 PMCID: PMC10544323 DOI: 10.3389/fsurg.2023.1223271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction A splenic artery aneurysm is considered an abnormal dilatation of the splenic artery layers greater than 1 cm in diameter. First described by Beaussier in 1770, it affects 1% of the population but carries a major risk for life-threatening complications of rupture in 3%-10% of cases regardless of its congenital or acquired etiology. The presentation is highly variable, from asymptomatic incidental discovery during routine imaging to aneurysmal rupture causing acute abdomen, massive gastrointestinal bleeding, and hemorrhagic shock. Case presentation Herein, we present a 19-year-old male patient who presented with epigastric pain and abdominal rigidity associated with a moderate amount of free peritoneal fluid that was found to be a ruptured SAA after immediate laparoscopy, which was successfully managed with splenectomy. Conclusion SAAs are a rare etiology of acute abdomen and hemorrhagic shock but have a very high risk of mortality even upon immediate intervention, requiring a very high level of vigilance and a low threshold for surgical intervention in unstable patients presenting with abdominal pain.
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Affiliation(s)
- Yumna Njoum
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Mohammed Maree
- Department of Surgery, Al-Makassed Hospital, Jerusalem, Palestine
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Anand A, Khurana S, Ateriya N, Sunil Kumar Sharma GA. Sudden death due to non-traumatic rupture of splenic artery aneurysm. Med Leg J 2021; 90:76-78. [PMID: 34259054 DOI: 10.1177/00258172211018339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Splenic artery aneurysm is a rare form of vascular pathology that carries a high risk of mortality once it gets ruptured. It has a prevalence of 1% and occurs due to thinning and dilatation of the arterial wall. CASE We describe a case of a 35-year-old policeman who died suddenly. At medico-legal autopsy, intraperitoneal clotted blood about 1000 g and liquid blood about 3000 ml were seen. On further exploration, ruptured splenic artery aneurysm about 2.0 cm in diameter became visible near the hilum. CONCLUSION Rare cases typically present as sudden and unexpected death with intraperitoneal bleed and may be confused with blunt trauma abdomen. Therefore, splenic artery aneurysm is an appropriate differential diagnosis for sudden deaths and intraperitoneal bleeding, respectively.
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Affiliation(s)
- Aditya Anand
- Department of Forensic Medicine, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, India
| | - Sahil Khurana
- Department of Forensic Medicine, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, India
| | - Navneet Ateriya
- Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences, Gorakhpur, India
| | - G A Sunil Kumar Sharma
- Department of Forensic Medicine, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, India
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Laparoscopic and Robotic Surgery for Splenic Artery Aneurysm: A Systematic Review. Ann Vasc Surg 2020; 68:527-535. [DOI: 10.1016/j.avsg.2020.05.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 01/27/2023]
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Pararas N, Rajendiran S, Taha I, Powar RR, Holguera C, Tadros E. Spontaneous Rupture of a Huge Splenic Artery Aneurysm: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e919956. [PMID: 31980593 PMCID: PMC6998792 DOI: 10.12659/ajcr.919956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Splenic artery aneurysm is uncommon in a healthy young male patient. With spontaneous rupture, it can quickly become life-threatening. Our aim is to highlight the possibility of splenic artery aneurysm among healthy young patients and its presentation as recurrent abdominal pain, while pending rupture is possible, which can present a diagnostic challenge. The rare occurrence and spontaneous rupture of a splenic artery aneurysm are often fatal outside an inpatient setting. CASE REPORT Here, we present the case of a 32-year-old patient who visited the Emergency Department with recurrent epigastric pain. While undergoing inpatient evaluation, had a spontaneous rupture of a splenic artery aneurysm with hypovolemic shock and a double-rupture phenomenon, necessitating emergency surgery. CONCLUSIONS With advances in modern imaging in recent years, the incidence of splenic aneurysm has increased 7-fold; therefore, being informed and considering it in the differential diagnosis might provide a window of opportunity and save lives.
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Affiliation(s)
- Nikolaos Pararas
- Department of Surgery, Dr. Sulaiman Al Habib Hospitals, Riyadh, Saudi Arabia
| | | | - Imad Taha
- Department of Surgery, Dr. Sulaiman Al Habib Hospitals, Riyadh, Saudi Arabia
| | | | - Carlos Holguera
- Department of Radiology, Dr. Sulaiman Al Habib Hospitals, Riyadh, Saudi Arabia
| | - Ezzat Tadros
- Department of Surgery, Dr. Sulaiman Al Habib Hospitals, Riyadh, Saudi Arabia
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Abstract
True splenic artery aneurysms (SAA) are a rare, but potentially fatal, pathology. They are the third most common type of abdominal aneurysm, after aneurysms of the aorta and of the iliac artery, and account for almost the all aneurysms of visceral arteries. True aneurysms account for 60% of SAA and affect four times as many women as men, generally related to increased incidental or symptomatic findings that coincide with use of ultrasonography in pregnancy. Among pregnant patients, mortality after rupture is 65-75%, with fetal mortality exceeding 90%. There are multiple etiologies and it is believed that hormonal influences and changes in portal flow during gestation play an important role in development of SAA. This review discusses their history, epidemiology, pathophysiology, and diagnosis and current treatment techniques.
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Ceccarelli G, Gusai G, Rondelli F, Balestra F, De Rosa M. Video-robotic aneurysmectomy for splenic artery aneurysm: case report and literature review. MINIM INVASIV THER 2019; 29:244-249. [PMID: 31250696 DOI: 10.1080/13645706.2019.1623819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We herein report the case of a symptomatic splenic artery aneurysm (SAA) diagnosed in a 65-year-old woman. Endoluminal exclusion was considered as first option, but the potential risk of postoperative splenic infarction, postsplenectomy thrombocytosis and immunodeficiency in an otherwise healthy patient raised the possibility to carry out a surgical procedure of vascular reconstruction using the robotic device Da Vinci® Surgical System (Intuitive Surgical, Sunnyvale, CA, USA). We performed the resection of the aneurysm and the continuity of the splenic artery was restored by end-to-end anastomosis.
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Affiliation(s)
- Graziano Ceccarelli
- Department of General Surgery, San Giovanni Battista Hospital, Foligno, Italy
| | - Giampietro Gusai
- Department of General Surgery, San Francesco Hospital, Nuoro, Italy
| | - Fabio Rondelli
- Department of General Surgery, San Francesco Hospital, Nuoro, Italy
| | | | - Michele De Rosa
- Department of General Surgery, San Giovanni Battista Hospital, Foligno, Italy
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Nasser HA, Kansoun AH, Sleiman YA, Mendes VM, Van Vyve E, Kachi A, Berjawi T, Hamdan WS, El Nakadi I. Different laparoscopic treatment modalities for splenic artery aneurysms: about 3 cases with review of the literature. Acta Chir Belg 2018; 118:212-218. [PMID: 29631508 DOI: 10.1080/00015458.2018.1459363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The first laparoscopic treatment of splenic artery aneurysm (SAA) was performed in 1993. Since then, many papers have been published mentioning different laparoscopic treatment modalities, including splenectomy, aneurysmectomy, ligation or even occlusion. PATIENTS AND METHODS An updated literature review of the English medical literature using the following MeSH, 'Lapaorscopic splenic artery aneurysm', 'laparoscopic aneurysectomy', 'Laparoscopic Splenic artery Aneurysm Ligation' and 'Laparoscopic Splenic artery aneurysm excision' was done. Also three cases performed at our institutions are discussed, in terms of techniques, morbidity, mortality and postoperative outcomes. RESULTS About eight case series and 16 case reports were retrieved from the literature. Different techniques were described by the authors, including splenectomy, aneurysmectomy, splenic aneurysm ligation or even occlusion. Few morbidity cases were reported and none of the authors has mentioned a single mortality case. In our three cases, the postoperative course was uneventful, with good long-term results. CONCLUSIONS Despite the variations in the adopted operative techniques, the laparoscopic approach seems to be harmless. However, no treatment algorithm or consensus has been published.
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Affiliation(s)
- Haydar A. Nasser
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
- Department of General and Digestive Surgery, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Alaa H. Kansoun
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
| | - Youssef A. Sleiman
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
| | - Vanessa Marron Mendes
- Department of General and Digestive Surgery, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Etienne Van Vyve
- Department of General and Digestive Surgery, Clinique Saint-Jean, Brussels, Belgium
| | - Antoine Kachi
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
| | - Tarek Berjawi
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
| | - Wajdi S. Hamdan
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
| | - Issam El Nakadi
- Department of General and Digestive Surgery, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Illuminati G, Pizzardi G, Pasqua R. Open surgery for aneurysms of the splenic artery at the hilum of the spleen: Report of three cases. Int J Surg Case Rep 2018; 48:47-49. [PMID: 29803194 PMCID: PMC6026722 DOI: 10.1016/j.ijscr.2018.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/08/2018] [Accepted: 05/13/2018] [Indexed: 01/12/2023] Open
Abstract
Aneurysms of the splenic artery at the hilum of the spleen are rare. Endovascular or laparoscopic treatment may not be advised. Surgical resection through subcostal incisioni s a viable treatment.
Introduction Aneurysms of the splenic artery (SAA) located at the hilum of the spleen are not well fit for endovascular or laparoscopic treatment. Open surgery may still be the best option of treatment. Presentation of cases We report the cases of 3 female patients of a mean age of 59 years (range, 45–68 years) with a hilar (n = 2) or parahilar (n = 1) SAA undergoing successful open surgical resection, through a short left subcostal access. Recovery was uneventful and mean, postoperative length of stay was 4 days (range, 3–5 days). Discussion Results of this report support surgical resection and splenectomy for the treatment of SAA located at the hilum of the spleen. For this particular location endovascular treatment may not be advised, as coil embolization can be followed by a massive splenic infarction precipitating the need for splenectomy, due to the exclusion of backflow from the left gastroepiploic artery through the short gastric vessels. As well, endovascular exclusion through insertion of an endograft may not be feasible due to the absence of a distal landing zone, as stent grafting requires a normal caliber artery of sufficient length on each side of the aneurysm. Conclusion Surgical excision and splenectomy, through a short subcostal incision, remains a viable option of treatment for hilar SAA.
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Affiliation(s)
- Giulio Illuminati
- The Department of Surgical Sciences, University of Rome "La Sapienza", Rome, Italy.
| | - Giulia Pizzardi
- The Department of Surgical Sciences, University of Rome "La Sapienza", Rome, Italy
| | - Rocco Pasqua
- The Department of Surgical Sciences, University of Rome "La Sapienza", Rome, Italy
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Toyoda Y, Kyokane T, Kawai T, Watanabe K, Koide F, Ochiai Y, Asai Y, Igami T, Kuze S. Laparoscopic surgery for the treatment of a ruptured aneurysm of the right gastric artery: a case report. Asian J Endosc Surg 2017; 10:70-74. [PMID: 27596384 DOI: 10.1111/ases.12323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/20/2016] [Accepted: 07/24/2016] [Indexed: 12/23/2022]
Abstract
Laparoscopic surgery for the treatment of a ruptured visceral artery aneurysm is recognized as a challenging procedure. Here, we describe our experience with laparoscopic surgery to treat a ruptured aneurysm of the right gastric artery. A 72-year-old woman was diagnosed with intra-abdominal hemorrhage caused by a ruptured aneurysm of the right gastric artery. Transcatheter arterial embolization failed because the right gastric artery could not be cannulated. Therefore, we performed laparoscopic surgery. Using laparoscopy, we detected that the bleeding from the aneurysm had ceased; thus, the planned procedure was successful. The operative time and intraoperative blood loss were 100 min and 5 mL, respectively. The patient was discharged 7 days after surgery. Laparoscopic surgery after the failure of transcatheter arterial embolization is a suitable and safe procedure for ruptured visceral artery aneurysms, provided the circulatory dynamics are stable as a result of the temporary cessation of bleeding from the ruptured aneurysm.
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Affiliation(s)
- Yoshitaka Toyoda
- Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan
| | - Takanori Kyokane
- Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan
| | - Toru Kawai
- Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan
| | | | - Fumihiko Koide
- Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan
| | - Yosuke Ochiai
- Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan
| | - Yuichi Asai
- Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan
| | - Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shingo Kuze
- Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan
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Małczak P, Wysocki M, Major P, Pędziwiatr M, Lasek A, Stefura T, Radkowiak D, Zub-Pokrowiecka A, Budzyński A. Laparoscopic approach to splenic aneurysms. Vascular 2016; 25:346-350. [PMID: 27903932 DOI: 10.1177/1708538116682164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Splenic artery aneurysm is a rare disease with possibly mortal complications. For years, the main method of treatment was excision of aneurysm with spleen. In recent years, several methods have been developed in order to salvage the spleen such endovascular techniques and aneurysmectomy. Objective The aim of our study was to determine the feasibility of laparoscopic aneurysmectomy with spleen salvage in cases of splenic artery aneurysm. Materials Analysis of prospectively gathered data containing records of patients operated laparoscopically due to diseases of the spleen in 1998-2016 in our department. Inclusion criteria were attempted laparoscopic aneurysmectomy with intent to salvage spleen. Results Out of 11 patients, seven patients underwent aneurysmectomy with spleen preservation, one patient had partial-splenectomy, two patients had intra-operative splenectomies and one patient had a re-operation on post-op day 1 with splenectomy. Re-operation with splenectomy was the only recorded complication. Conclusions Laparoscopic aneurysmectomy of SAA may be considered as a safe treatment method, with good short- and long-term results; however, a complete evaluation requires further research on a larger study group. It allows permanent treatment of SAA with maintaining spleen function.
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Affiliation(s)
- Piotr Małczak
- 1 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,2 Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Wysocki
- 3 Students' Scientific Group, 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Major
- 1 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,2 Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Pędziwiatr
- 1 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,2 Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Lasek
- 1 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,2 Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Stefura
- 3 Students' Scientific Group, 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Dorota Radkowiak
- 1 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,2 Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Zub-Pokrowiecka
- 1 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,2 Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Budzyński
- 1 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,2 Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Jagiellonian University Medical College, Krakow, Poland
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Abstract
Superior mesenteric artery aneurysm (SMAA) is reported to be the third-most common type of visceral aneurysm (VA), accounting for 5% of all VAs. The etiology of SMAA is commonly thought to be infection, and it usually exists in the proximal part of the superior mesenteric artery, which is suitable for endovascular treatment. We herein report an extremely rare case of the distal part of SMAA caused by Takayasu's arteritis (TA), which was successfully resected using a mini-laparotomy method without impairing the intestinal blood supply. A 51-year-old woman was admitted to our hospital with sustained fever and lower back pain. Physical examination showed that she had a discrepancies in blood pressure between both arms. Contrast-enhanced whole-body computed tomography showed stenosis of the thoracic aorta and an aneurysm located in the distal part of the superior mesenteric artery. The diameter of the aneurysm was 4.5 cm. The aneurysm was resected via 4-cm mini-laparotomy, and the vascularity of the intestine was successfully preserved. The postoperative course was uneventful, and the patient was diagnosed as having TA based on both clinical and pathologic findings. Additional corticosteroid therapy was started to treat the arteritis, and at 3-month follow-up she was without critical incidents. Mini-laparotomy is a safe and less-invasive approach to treat SMAA, especially when the lesion is located in the distal part of the artery.
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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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Abdulrahman A, Shabkah A, Hassanain M, Aljiffry M. Ruptured spontaneous splenic artery aneurysm: A case report and review of the literature. Int J Surg Case Rep 2014; 5:754-7. [PMID: 25240215 PMCID: PMC4189090 DOI: 10.1016/j.ijscr.2014.08.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/07/2014] [Accepted: 08/24/2014] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Splenic artery aneurysm is a rare condition, however, potentially fatal. The importance of splenic artery aneurysm lies in the risk for rupture and life threatening hemorrhage. PRESENTATION OF CASE This is a case of a ruptured splenic artery aneurysm in a 58-year-old lady. She presented with hypovolemic shock and intra-peritoneal bleeding. Diagnosis was confirmed by CT angiography and she was managed by operative ligation of the aneurysm with splenectomy and distal pancreatectomy. DISCUSSION The literature pointed the presence of some risk factors correlating to the development of splenic artery aneurysm. In this article we discuss a rare case of spontaneous (idiopathic) splenic artery aneurysm and review the literature of this challenging surgical condition. CONCLUSION Splenic artery aneurysm needs prompt diagnosis and management to achieve a favorable outcome, high index of suspicion is needed to make the diagnosis in the absence of known risk factors.
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Affiliation(s)
- Aisha Abdulrahman
- Department of Surgery, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Alaa Shabkah
- Department of Surgery, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mazen Hassanain
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Murad Aljiffry
- Department of Surgery, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
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Wei YH, Xu JW, Shen HP, Zhang GL, Ajoodhea H, Zhang RC, Mou YP. Laparoscopic ligation of proximal splenic artery aneurysm with splenic function preservation. World J Gastroenterol 2014; 20:4835-4838. [PMID: 24782641 PMCID: PMC4000525 DOI: 10.3748/wjg.v20.i16.4835] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/28/2013] [Accepted: 03/05/2014] [Indexed: 02/06/2023] Open
Abstract
Splenic artery aneurysm is one of the most common visceral aneurysms, and patients with this type of aneurysm often present without symptoms. However, when rupture occurs, it can be a catastrophic event. Although most of these aneurysms can be treated with percutaneous embolization, some located in uncommon parts of the splenic artery may make this approach impossible. We present a patient with an aneurysm in the proximal splenic artery, close to the celiac trunk, which was treated by laparoscopic ligation only, without resection of the aneurysm, and with long-term preservation of splenic function.
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Iida A, Katayama K, Yamaguchi A. Laparoscopic resection for splenic artery aneurysm using the lateral approach: report of two cases. Asian J Endosc Surg 2013; 6:147-50. [PMID: 23602003 DOI: 10.1111/ases.12000] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 08/22/2012] [Accepted: 09/11/2012] [Indexed: 11/28/2022]
Abstract
We report two cases of successful laparoscopic surgery for splenic artery aneurysm. In case 1, a 59-year-old man who had hypertension was admitted to the hospital with complaints of slight back pain. CT scan showed a winding splenic artery and an aneurysm behind the pancreas body. In case 2, a 71-year-old woman with hypertension consulted us and was diagnosed with splenic artery aneurysm. Her aneurysm increased from 1.2 mm to 20 mm at the 1-year follow-up. In both cases, we performed laparoscopic splenectomy, using the left lateral approach, to resect the aneurysm. Splenectomy was performed after the spleen had changed color. The operating times were 210 and 259 min, respectively and the bleeding was 60 and 100 mL, respectively. The postoperative course was uneventful. By using the lateral approach from the left side, we were able to precisely resect the splenic artery aneurysm under a stable laparoscopic view.
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Affiliation(s)
- Atsushi Iida
- Department of Gastroenterological Surgery, University of Fukui, Fukui, Japan.
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Rare aneurysm of the hepatic artery with overlap to the gastroduodenal artery in very uncommon coincidence with occurence of hepatomesenteric trunk. Wien Klin Wochenschr 2013; 125:111-4. [PMID: 23420527 DOI: 10.1007/s00508-012-0317-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 12/06/2012] [Indexed: 01/17/2023]
Abstract
BACKGROUND Aneurysms of visceral arteries are rare, but in case of rupture, they are potentially life threatening. In addition, there is a broad spectrum of the anatomic variability for the arterial supply of the liver. METHODS Based on a real but very rare clinical case, including its diagnostic management and short-term course, the extraordinary coincidence of (i) an aneurysm of the gastroduodenal artery at its branching off from the hepatic artery and (ii) occurrence of hepatomesenteric trunk is described by the means of a scientific medical case report as well as an adequate and selective literature search. CASE PRESENTATION, THERAPEUTIC DECISION AND CLINICAL COURSE: A 39-year-old woman (BMI, 24 kg/m) was diagnosed (by coincidence) with an aneurysm of the proper hepatic artery (APHA) with overlap to the gastroduodenal artery in combination with an uncommon hepatomesenteric trunk using abdominal computed tomography (CT) scan (because of slight but recurrent episodes of urinary tract diseases) and, subsequently, systematic diagnostic comprising Duplex ultrasonography, magnetic resonance imaging (MRI), and conventional angiography. However, medical history was not significant for coincidence with possibly relevant chronic occlusive disease, mycotic embolization, trauma, Marfan syndrome, Klippel-Trenaunay syndrome or giant cell arteritis. Despite a moderate progression within a year to a size of actually 18 mm, we still favor watchful-waiting at this size (therapeutic [interventional] consequence, size > 20 mm) with short-term intervals for follow-up investigations using Duplex ultrasonography as the method of choice. CONCLUSIONS This is the first case in the accessible English-speaking literature to show this very infrequent coincidence especially indicating rare appearance of an APHA in combination with an also infrequent hepatomesenteric trunk (which potentiates the uncommon occurrence of such combination) based on the high anatomic variability of the arterial supply of the liver from the anatomic perspective.
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Samamé J, Kaul A, Garza U, Echeverria A, Galvani C. Laparoscopic aneurysm resection and splenectomy for splenic artery aneurysm in the third trimester of pregnancy. Surg Endosc 2013; 27:2988-91. [DOI: 10.1007/s00464-013-2822-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 01/07/2013] [Indexed: 01/13/2023]
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Rodríguez-Caulo EA, Araji O, Miranda N, Téllez JC, Velázquez C. [Fusiform giant splenic artery aneurysm]. Cir Esp 2012; 92:215-6. [PMID: 23219207 DOI: 10.1016/j.ciresp.2012.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 11/28/2011] [Accepted: 01/05/2012] [Indexed: 11/16/2022]
Affiliation(s)
- Emiliano A Rodríguez-Caulo
- Servicio de Cirugía Cardiovascular, UGC Área del Corazón, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - Omar Araji
- Servicio de Cirugía Cardiovascular, UGC Área del Corazón, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Nuria Miranda
- Servicio de Cirugía Cardiovascular, UGC Área del Corazón, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Juan C Téllez
- Servicio de Cirugía Cardiovascular, UGC Área del Corazón, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Carlos Velázquez
- Servicio de Cirugía Cardiovascular, UGC Área del Corazón, Hospital Universitario Virgen Macarena, Sevilla, España
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Tiberio GAM, Bonardelli S, Gheza F, Arru L, Cervi E, Giulini SM. Prospective randomized comparison of open versus laparoscopic management of splenic artery aneurysms: a 10-year study. Surg Endosc 2012. [PMID: 22752279 DOI: 10.1007/s00464-012-2413-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 05/21/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND: The literature does not support the choice between open and laparoscopic management of splenic artery aneurysms (SAA). METHODS: We designed a prospective, randomized comparison between open and laparoscopic surgery for SAA. Primary end points were types of surgical procedures performed and clinical outcomes. Analysis was developed on an intention-to-treat basis. RESULTS: Fourteen patients were allocated to laparotomy (group A) and 15 to laparoscopy (group B). Groups displayed similar patient- and aneurysm-related characteristics. The conversion rate to open surgery was 13.3 %. The type of surgical procedure performed on the splenic artery was similar in the two groups: aneurysmectomy with splenic artery ligature or direct anastomosis was performed in 51 % and 21 % of patients in group A and in 60 % and 20 % in group B, respectively. The splenectomy rate was similar (14 % vs. 20 %). Postoperative splenic infarction was observed in one case in each group. Laparoscopy was associated with shorter procedures (p = 0.0003) and lower morbidity (25 % vs. 64 %, p = 0.045). Major morbidity requiring interventional procedures and blood transfusion was observed only in group A. Laparoscopy was associated with quicker resumption of oral diet (p < 0.001), earlier drain removal (p = 0.046), and shorter hospital stay (p < 0.01). During a mean follow-up of 50 months, two patients in group A required hospital readmission. In group B, two patients developed a late thrombosis of arterial anastomoses. CONCLUSIONS: Our study demonstrates that laparoscopy permits multiple technical options, does not increase the splenectomy rate, and reduces postoperative complications. It confirms the supposed clinical benefits of laparoscopy when ablative procedures are required but laparoscopic anastomoses show poor long-term results.
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Affiliation(s)
- Guido A M Tiberio
- General Surgery, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy,
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Patel A, Weintraub JL, Nowakowski FS, Kim E, Fischman AM, Ellozy SH, Faries PL, Vouyouka AG, Marin ML, Lookstein RA. Single-center experience with elective transcatheter coil embolization of splenic artery aneurysms: technique and midterm follow-up. J Vasc Interv Radiol 2012; 23:893-9. [PMID: 22579853 DOI: 10.1016/j.jvir.2012.03.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 03/13/2012] [Accepted: 03/29/2012] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To review a single-center experience with elective coil embolization of splenic artery aneurysm (SAA) and analyze efficacy of the technique at midterm follow-up. MATERIALS AND METHODS From 2002 through 2011, 50 patients (28 women, 22 men; age range, 24-89 y; mean age, 53.5 y ± 13.6) underwent transcatheter coil embolization for treatment of SAAs. Pseudoaneurysms and ruptured aneurysms were excluded. A total of 63 SAAs were treated (size, 13-97 mm; mean, 29 mm). Ninety-eight percent of aneurysms were treated with coils alone. Regular follow-up consisted of an office visit and imaging. Patient medical records were reviewed for aneurysm location, procedural approach, and technical and clinical outcomes. RESULTS Ninety-eight percent of procedures were technically successful at thrombosing the aneurysm at the time of procedure. Repeat intervention was performed in four of 47 patients (9%) because of continued aneurysm perfusion at follow-up. Mean time to repeat intervention was 125 days (range, 42-245 d). All repeat interventions were technically successful. Neither aneurysm growth nor aneurysm rupture was observed in any patient during the follow-up period (mean, 78 weeks; range, 9 d to 7.1 y). There were no major adverse events. Major splenic infarction occurred in three of 33 patients (9%) with no underlying liver disease and normal splenic volume and in seven of 14 patients (50%) with portal hypertension. CONCLUSIONS Percutaneous transcatheter coil embolization is a safe, effective, and minimally invasive treatment for SAAs as evidenced by high rates of technical success and freedom from aneurysm rupture.
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Affiliation(s)
- Amish Patel
- Division of Interventional Radiology, Mount Sinai Medical Center, 1 Gustave L. Levy Place, New York, NY 10029, USA
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Moriyama H, Ishikawa N, Kawaguchi M, Inaki N, Watanabe G. Laparoscopic approaches for splenic artery aneurysms. MINIM INVASIV THER 2011; 21:362-5. [PMID: 22098441 DOI: 10.3109/13645706.2011.636051] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Therapeutic options for splenic artery aneurysm include endovascular management, laparoscopic surgery, and open surgery, although their indications and applications as standard therapy remain controversial. METHODS Between August 2009 and March 2011, three patients with splenic artery aneurysm were treated at our institution. All patients underwent laparoscopic surgery. RESULTS There was no conversion to open surgery. The mean operative time was 204.7 min (range: 147-265 min) and the mean intraoperative blood loss was 30 mL (range: 0-90 mL). There was no mortality or morbidity. CONCLUSIONS The laparoscopic approaches for splenic artery aneurysm were safe procedures.
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Affiliation(s)
- Hideki Moriyama
- Department of General and Cardiothoracic Surgery, Kanazawa University Kanazawa, Japan.
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Saba L, Anzidei M, Lucatelli P, Mallarini G. The multidetector computed tomography angiography (MDCTA) in the diagnosis of splenic artery aneurysm and pseudoaneurysm. Acta Radiol 2011; 52:488-98. [PMID: 21498313 DOI: 10.1258/ar.2011.100283] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Splenic artery aneurysm is the most frequent visceral artery aneurysm and rupture of the aneurysm is associated with a high mortality rate. It is important to discriminate between a true aneurysm and a pseudoaneurysm that may be caused by pancreatitis, iatrogenic and postoperative causes, trauma and peptic ulcer disease. Multidetector-row CT angiography (MDCTA) allows detailed visualization of the vascular anatomy and may allow identification of aneurysms and pseudoaneurysms that affect the splenic artery. The objective of this article is to provide a review of the general characteristics of splenic artery aneurysms and pseudoaneurysms and to describe the findings of MDCTA.
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Affiliation(s)
- Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (AOU), Cagliari
| | - Michele Anzidei
- Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy
| | - Pierleone Lucatelli
- Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy
| | - Giorgio Mallarini
- Department of Radiology, Azienda Ospedaliero Universitaria (AOU), Cagliari
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Kelly MD, Nabti H, Lear PA, Baker AR, Jones L. Combined laparoscopic cholecystectomy and ligation of splenic artery aneurysm. ANZ J Surg 2010; 80:554-5. [PMID: 20795973 DOI: 10.1111/j.1445-2197.2010.05382.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Michael D Kelly
- Department of Upper GI Surgery, Southmead Hospital, Bristol, United Kingdom
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Antonopoulos C, Karagianni M, Galanakis N, Vagianos C. Mycotic Splenic Artery Aneurysm Secondary to Coxiella burnetii Endocarditis. Ann Vasc Surg 2010; 24:416.e13-6. [DOI: 10.1016/j.avsg.2009.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 05/27/2009] [Indexed: 10/20/2022]
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Abstract
Splenic artery aneurysm is the third most common intra-abdominal aneurysm with a prevalence as high as 10% in some studies. Widespread use of abdominal imaging has resulted in the increasing detection of asymptomatic incidental aneurysms. In this manuscript we review the changing incidence, risk factors and evolving therapeutic options in the era of minimally invasive therapy and have developed a treatment algorithm for practical use. Aneurysms with a low risk of rupture may be treated conservatively but require regular imaging to ascertain progress. Available evidence suggests that splenic artery aneurysms that are symptomatic, enlarging, more than 2 cm in diameter or those detected in pregnancy, childbearing age or following liver transplantation are at high risk of rupture and should undergo active treatment. Prophylactic screening should be reserved for those with multiple risk factors, such as pregnancy in liver transplant recipients. All false aneurysms should also be treated. The primary therapeutic approach should be endovascular therapy by either embolization or stent grafting.
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Ousadden A, Ibnmajdoub KH, Elbouhaddouti H, Mazaz K, Aittaleb K. Intragastric rupture of a splenic artery aneurysm - a case report. CASES JOURNAL 2009; 2:202. [PMID: 20062707 PMCID: PMC2803867 DOI: 10.1186/1757-1626-2-202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 11/18/2009] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Hematemesis caused by intragastric rupture of a splenic artery aneurysm, is an exceptional and potentially lethal emergency. CASE PRESENTATION A 36 years old woman, mother of seven children presented with hematemesis. The gastric endoscopy revealed a bleeding polypoid lesion leading to a surgical management. The operative discovery of a complicated splenic artery aneurysm, led to its resection with splenectomy and gastric suture. CONCLUSION Intragastric rupture of a splenic artery aneurysm is an exceptional emergency which urgent diagnosis and management can avoid a potential lethal evolution.
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Affiliation(s)
- Abdelmalek Ousadden
- Service de chirurgie générale - Hôpital des spécialités - CHU de Fès - Route de Sidi Harazem - Fès - 30070 - Morocco
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Abstract
PURPOSE We describe 6 cases of laparoscopic splenectomy for multiple, fusiform splenic artery aneurysm (SAA) in patients difficult to treat with interventional radiology procedure and present a literature review. METHODS Between November 1999 and May 2008, 6 patients with SAA underwent laparoscopic surgery. Among these patients, 4 had splenectomy alone and 2 had splenectomy with distal pancreatectomy. The mean size of the aneurysm was 3.1 cm (range: 2 to 4 cm). RESULTS Laparoscopic surgeries for SAA were completed successfully in all the 6 patients. The mean operative time and the blood loss were 186.7 minutes (range: 115 to 300 min) and 187.8 mL (range: 3 to 850 mL). The length of the hospital stay was 8.5 days (range: 3 to 15 d). In only 1 case, portal system thrombosis was observed, and the other serious morbidities such as hemorrhage or pancreatic leakage were not observed. No recurrence was observed during a mean follow-up period of 116 months (range: 14 to 260 mo). CONCLUSIONS Laparoscopic surgery should be considered to be a safe therapeutic option for SAA patients with the risk of rupture who are difficult to treat with interventional radiology therapy.
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Pietrabissa A, Ferrari M, Berchiolli R, Morelli L, Pugliese L, Ferrari V, Mosca F. Laparoscopic treatment of splenic artery aneurysms. J Vasc Surg 2009; 50:275-9. [PMID: 19631859 DOI: 10.1016/j.jvs.2009.03.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 03/11/2009] [Accepted: 03/12/2009] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The purpose of this study was to report a series of 16 consecutive patients who underwent laparoscopic treatment of splenic artery aneurysms. METHODS Over a period of 8 years, patients were selected for the laparoscopic option by a team of specialists that included the vascular surgeon, the interventional radiologist, and the laparoscopic surgeon. The mean size of the aneurysm was 32 mm and most was located at the splenic hilum. They were twice as common in females as in males. Ultrasonography with color Doppler function was used to define intraoperative strategy. RESULTS The laparoscopic treatment entailed excision of the aneurysm or its exclusion, usually reserved for distally located lesions. In one patient, laparoscopic resection and robotic anastomosis of the splenic artery was performed to re-establish flow to the spleen. In two patients, the intraoperative decision was added to combine a laparoscopic splenectomy due to insufficient residual arterial flow to the spleen. There was no conversion, or need for re-operation or related mortality. Analysis of intraoperative arterial flow data avoided unnecessary splenectomy following noncritical reduction of flow to the spleen. CONCLUSIONS The use of intraoperative color Doppler ultrasonography is essential in deciding the appropriate procedure and whether the spleen should be removed or saved. Early control of the splenic artery proximal to the aneurysm can limit the risk of conversion due to intraoperative bleeding. Distally located aneurysms are more difficult to manage and entail a higher risk of associated splenectomy. The laparoscopic option offers some advantages over the endovascular treatment in selected patients. A multidisciplinary approach is the key to a successful treatment of this uncommon disease.
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Affiliation(s)
- Andrea Pietrabissa
- Divisione di Chirurgia I Universitaria, Dipartimento di Oncologia, dei Trapianti e delle Nuove Tecnologie in Medicina, Università di Pisa, Pisa, Italy.
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Grotemeyer D, Duran M, Park EJ, Hoffmann N, Blondin D, Iskandar F, Balzer KM, Sandmann W. Visceral artery aneurysms—follow-up of 23 patients with 31 aneurysms after surgical or interventional therapy. Langenbecks Arch Surg 2009; 394:1093-100. [DOI: 10.1007/s00423-009-0482-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 03/02/2009] [Indexed: 10/21/2022]
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Pulli R, Dorigo W, Troisi N, Pratesi G, Innocenti AA, Pratesi C. Surgical treatment of visceral artery aneurysms: A 25-year experience. J Vasc Surg 2008; 48:334-42. [PMID: 18644480 DOI: 10.1016/j.jvs.2008.03.043] [Citation(s) in RCA: 216] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Revised: 03/19/2008] [Accepted: 03/22/2008] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to analyze our 25-year experience with surgical treatment of visceral artery aneurysms (VAAs), with particular attention paid to early and long-term results. MATERIALS AND METHODS From January 1982 to September 2007, 55 patients (32 males, 58%, and 23 females, 42%) underwent surgical treatment of 59 VAAs. Only one patient was treated with an endovascular procedure. Mean patient age was 59.3 years (range, 36-78 years). The site of aneurysmal disease was splenic artery in 30 (50.8%) cases, renal artery in nine (15.2%) cases, common hepatic artery in seven (11.9%) cases, pancreaticoduodenal artery in four (6.8%) cases, celiac trunk in three (5.1%) cases, superior mesenteric artery in two (3.4%) cases, and gastroduodenal, inferior mesenteric, middle colic and right gastroepiploic in one (1.7%) case for each artery. Two (3.6%) patients had multiple VAAs. In five (9.1%) patients, an abdominal aortic aneurysm coexisted. Early results in terms of mortality and major complications were assessed. Follow-up consisted of clinical and ultrasound examinations at 1 and 12 months, and yearly thereafter. Long-term results in terms of survival and aneurysm-related complications were analyzed. RESULTS In all but two cases, elective intervention in asymptomatic patients was performed. Two (3.6%) patients had a ruptured aneurysm (one pancreaticoduodenal artery and one middle colic artery). The one perioperative death was due to an acute pancreatitis in a patient operated on for a giant inflammatory splenic artery aneurysm, yielding a perioperative mortality rate of 1.8%. Two major complications (retroperitoneal hematoma and acute pancreatitis) were recorded. Mean duration of follow-up was 82.1 months (range, 0-324 months). Estimated 10-year survival rate was 79.5%. During follow-up two aneurysm-related complications occurred, with an estimated 10-year, aneurysm-related, complication-free survival rate of 75.2%. CONCLUSION In the era of minimally invasive therapeutic approaches, elective open surgical treatment of visceral artery aneurysms is safe and effective, and offers satisfactory early and long-term results.
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Affiliation(s)
- Raffaele Pulli
- Department of Vascular Surgery, University of Florence, Florence, Italy.
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Illuminati G, LaMuraglia G, Nigri G, Vietri F. Surgical repair of an aberrant splenic artery aneurysm: report of a case. Ann Vasc Surg 2007; 21:216-8. [PMID: 17349366 DOI: 10.1016/j.avsg.2006.06.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Revised: 05/24/2006] [Accepted: 06/09/2006] [Indexed: 12/13/2022]
Abstract
Aneurysms of the splenic artery are the most common splanchnic aneurysms. Aneurysms of a splenic artery with an anomalous origin from the superior mesenteric artery are however rare, with eight previously reported cases. Their indications for treatment are superposable to those of aneurysms affecting an orthotopic artery. Methods of treatment of this condition include endovascular, minimally invasive techniques and surgical resection. We report one more case of aneurysm of an aberrant splenic artery, treated with surgical resection, and preservation of the spleen.
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Affiliation(s)
- Giulio Illuminati
- The Francesco Durante Department of Surgery, University of Rome La Sapienza, Rome, Italy.
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Varnagy D, Sendzischew M, Hertz JA, Sendzischew H. Endovascular management of a ruptured splenic artery aneurysm. Vasc Endovascular Surg 2007; 41:68-72. [PMID: 17277246 DOI: 10.1177/1538574406290209] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- David Varnagy
- Mount Sinai Medical Center, Greater Miami Beach, Florida, USA.
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Piffaretti G, Tozzi M, Lomazzi C, Rivolta N, Riva F, Caronno R, Castelli P. Splenic artery aneurysms: postembolization syndrome and surgical complications. Am J Surg 2007; 193:166-70. [PMID: 17236842 DOI: 10.1016/j.amjsurg.2006.09.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Revised: 09/13/2006] [Accepted: 09/13/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study assessed the endovascular embolization of splenic artery aneurysms and false aneurysms with special consideration given to postoperative complications. METHODS Fifteen patients (11 women; mean age, 56 y; range, 39-80 y) with splenic artery aneurysm (n = 13) or false aneurysm (n = 2) were treated with coil embolization. The lesion was asymptomatic in 9 patients, symptomatic in 5 patients, and ruptured in 1 patient. The mean aneurysm diameter was 33 +/- 23 mm (range, 15-80 mm). Postoperative follow-up evaluation included a clinical visit and spiral computed tomography at 1, 4, and 12 months, and yearly thereafter. RESULTS Endovascular treatment was possible in 14 patients (93%) (1 failure: neck cannulation). Perioperative mortality was not observed. Morbidity included postembolization syndrome in 5 patients (30%). Neither pancreatitis nor spleen abscess occurred. The mean follow-up period was 36 months (range, 3-60 mo). During follow-up evaluation we detected 1 sac reperfusion that was sealed successfully with additional coils. Surgical conversion or open repair were never required. CONCLUSIONS At our institute, endovascular treatment represents the first-line treatment for splenic artery aneurysms. Postembolization syndrome and infarcts are common events but generally resolve without sequelae.
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Affiliation(s)
- Gabriele Piffaretti
- Vascular Surgery, Department of Surgery, University of Insubria-Varese, Ospedale di Circolo, 21100 viale Borri 57, Varese, Italy.
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Sachdev U, Baril DT, Ellozy SH, Lookstein RA, Silverberg D, Jacobs TS, Carroccio A, Teodorescu VJ, Marin ML. Management of aneurysms involving branches of the celiac and superior mesenteric arteries: a comparison of surgical and endovascular therapy. J Vasc Surg 2006; 44:718-24. [PMID: 17011997 DOI: 10.1016/j.jvs.2006.06.027] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 06/25/2006] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Aneurysms involving branches of the superior mesenteric and celiac arteries are uncommon and require proper management to prevent rupture and death. This study compares surgical and endovascular treatment of these aneurysms and analyzes outcome. METHODS Patients at the Mount Sinai Medical Center in New York who were treated for aneurysms in the branches of the celiac artery and superior mesenteric artery were identified through a search of the institution's medical records and endovascular database. Patient demographics, history, clinical presentation, aneurysm characteristics, treatments, and follow-up outcome were retrospectively recorded. Significant differences between patients treated by surgical or endovascular therapy were determined by using Student's t test and chi2 analysis. RESULTS Between January 1, 1991, and July 1, 2005, 59 patients with 61 aneurysms were treated at a single institution. Twenty-four patients had surgical repair, and 35 underwent endovascular treatment, which included coil embolization and stent-graft therapy. Splenic (28) and hepatic (22) artery aneurysms predominated. Eighty-nine percent of splenic artery aneurysms were true aneurysms and were treated by endovascular and surgical procedures in near equal numbers (14 and 11, respectively). Pseudoaneurysms were significantly more likely to be treated by endovascular means (P < .01). The technical success rate of endovascular treatment for aneurysms was 89%, and failures were successfully treated by repeat coil embolization in all patients who presented for retreatment. Patients treated by endovascular techniques had a significantly higher incidence of malignancy than patients treated with open surgical techniques (P = .03). Furthermore, patients treated by endovascular means had a shorter in-hospital length of stay (2.4 vs 6.6 days, P < .001). CONCLUSION Endovascular management of visceral aneurysms is an effective means of treating aneurysms involving branches of the celiac and superior mesenteric arteries and is particularly useful in patients with comorbidities, including cancer. It is associated with a decreased length of stay in the elective setting, and failure of primary treatment can often be successfully managed percutaneously.
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Affiliation(s)
- Ulka Sachdev
- Division of Vascular Surgery, Department of Surgery, Mount Sinai Medical Center, New York, NY 10029, USA.
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