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Pandey M, Mathew J, Majzoub R, Nugent K. Splenic artery embolization complicated by pleural effusion. Am J Med Sci 2024; 368:392-398. [PMID: 38925428 DOI: 10.1016/j.amjms.2024.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
This case report and review describes a 31-year-old man with a history of chronic pancreatitis who presented to the hospital with shortness of breath and left-sided chest pain. Three days prior, he underwent mid-splenic artery embolization due to hematemesis attributed to a splenic artery pseudoaneurysm associated with a peripancreatic pseudocyst. Upon this presentation, the patient reported increasing shortness of breath, left-sided pleuritic chest pain, and epigastric and left upper quadrant abdominal pain. Imaging revealed left pleural effusion, splenic infarcts, and adjacent fluid collections. Thoracentesis confirmed an exudative effusion. The pleural effusion was attributed to recent splenic artery embolization, and the patient was discharged on appropriate medications in stable condition on the sixth day of hospitalization. This case underscores the importance of considering embolization-related complications in the differential diagnosis of pleural effusions following such procedures. The etiology, diagnosis, and management of splenic artery aneurysms are discussed in this review.
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Affiliation(s)
- Mandvi Pandey
- Department of Internal Medicine, Texas Health Resources, Denton Texas, USA
| | - Joscilin Mathew
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Reham Majzoub
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA.
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Rinaldi V, Illuminati G, Caronna R, Prezioso G, Palumbo P, Saullo P, D’Andrea V, Nardi P. The Definition, Diagnosis, and Management of Giant Splenic Artery Aneurysms and Pseudoaneurysms: A Systematic Review. J Clin Med 2024; 13:5793. [PMID: 39407852 PMCID: PMC11477110 DOI: 10.3390/jcm13195793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 09/20/2024] [Accepted: 09/24/2024] [Indexed: 10/20/2024] Open
Abstract
Background/Objectives: Giant splenic artery aneurysms (SAAs) and pseudoaneurysms (SAPs) represent rare conditions, characterized by a diameter greater than or equal to 5 cm. The risk of rupture is increased compared to common SAAs and SAPs, necessitating urgent treatments to prevent it. Methods: This systematic review was conducted through a comprehensive search involving the PubMed, Google Scholar, and Scopus databases. A total of 82 patients and 65 articles were included in the analysis. For each patient, we investigated age, sex, symptoms, comorbidities, the presence of a true or a false aneurysm, the dimensional criteria used to define dilations as giant aneurysms or pseudoaneurysms, the dimension of the two greatest diameters, imaging studies, surgical treatment, post-operative length of stay (LOS), and post-operative follow-up. Results: The results revealed a similar incidence in both genders (43 males vs. 39 females) with a median age of 55.79 years. The most frequently described symptom was pain (59.76%). Thirteen cases were false aneurysms and 69 were true aneurysms. The mean greatest diameter was 9.90 cm. The CT scan was the most utilized imaging study (80.49%). Open, endovascular, and hybrid surgery were performed in 47, 26, and 9 patients, respectively, with complication rates of 14.89%, 23.08%, and 22.22% occurring for each treatment. The post-operative LOS was 12.29 days, 2.36 days, and 5 days, respectively. The median follow-up was 17.28 months overall. No recanalization was observed after endovascular procedures during the follow-up period. Conclusions: The dimensional criterion to define SAAs and SAPs as giant was most frequently that at least one diameter was ≥ 5 cm. The CT scan was the most frequently utilized radiological study to diagnose giant SAAs and SAPs. Finally, endovascular procedures, open surgeries, and hybrid treatments presented similar post-operative complication rates. The post-operative LOS was lower for the endovascular group, and the follow-up period did not show aneurysm recanalization in any patients.
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Affiliation(s)
- Valerio Rinaldi
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (G.I.); (R.C.); (G.P.); (P.P.); (P.S.); (V.D.)
| | | | | | | | | | | | | | - Priscilla Nardi
- Department of Surgery, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy; (G.I.); (R.C.); (G.P.); (P.P.); (P.S.); (V.D.)
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3
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Zain AM, Sires AM, Al-Jawad M, Alkanj H. Ruptured giant splenic artery aneurysm with an exceptional concurrent gastric and transverse colonic fistula: A rare case report. Medicine (Baltimore) 2024; 103:e39159. [PMID: 39093788 PMCID: PMC11296425 DOI: 10.1097/md.0000000000039159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/11/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Splenic artery aneurysm (SAA) is a focal dilation of the splenic artery with varying etiologies including atherosclerosis, arteritis, or trauma. Giant SAAs with a diameter of 10 cm is rare and can lead to severe complications like rupture and fistulas. Therefore, an accurate and timely diagnosis and treatment are important. PATIENT CONCERNS A 50-year-old male presented with acute epigastric pain and hemorrhagic shock. Considering his symptoms and examination, ultrasound, multi-slice computed tomography and digital subtraction angiography results, a ruptured giant splenic artery aneurysm complicated with an exceptional gastric and transverse colonic fistula was suspected. DIAGNOSIS Ruptured giant splenic artery aneurysm. INTERVENTIONS Left anterolateral thoracotomy to control the severe aortic bleeding just above the diaphragm, aneurysmectomy, splenectomy, and closing the gastric and transverse colon perforations. OUTCOMES Multi-slice computed tomography demonstrated the presence of splenic artery aneurysm in the distal third measuring (10 × 12 cm) in diameter with a true lumen measuring (7 × 3.5 cm) and a large hematoma extending to the greater and lesser gastric curvature. Intraoperatively, a large pulsating mass was detected occupying the epigastrium and the left hypochondrium with severe adhesions with the stomach and transverse colon. CONCLUSION Giant SAA with a diameter of 10 cm is rare and is associated with severe complications. Therefore, successful treatment of splenic artery aneurysms involves prompt diagnosis, immediate surgical intervention to control bleeding, and tailored approaches like thoracotomy to control the thoracic aorta for better hemodynamic stabilization, aiming to eliminate the aneurysm and reduce complications effectively.
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Affiliation(s)
- Abdo Mohamad Zain
- Department of Vascular Surgery, Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | | | - Mohammad Al-Jawad
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Hussein Alkanj
- Department of Vascular Surgery, Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
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Salimi J, Nikraftar P, Rashidi F, Azimi M, Shokri A. Emergent method for management of splenic artery aneurysms rupture: A case report. Int J Surg Case Rep 2024; 116:109406. [PMID: 38432167 PMCID: PMC10943993 DOI: 10.1016/j.ijscr.2024.109406] [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: 01/08/2024] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Although endovascular therapy is becoming more used for the treatment of splenic artery aneurysms (SAAs) instead of open surgery, there is limited information available on the emergent hybrid approach, selectively. We present our experience of hybrid therapy using an emergent endovascular balloon for inflow control and open resection. CASE PRESENTATION A 34-year-old woman was brought to the emergency room after it was reported that she had a pseudoaneurysm in her splenic artery at a different medical facility. The patient was hemodynamically stable. Then we underwent a combination of endovascular and open procedures, using balloon proximal control and open aneurysm resection. She was discharged from hospital on the fifth postoperative day after the operation. CLINICAL DISCUSSION There is no agreement on how to treat SAA patients. Endovascular procedures such as endovascular intervention are also being used, minimizing the risks of surgery and shortening the patient's hospital stay, but complications remain. We propose to try SAA's emergency hybrid strategy operation with a good prognosis and fewer complications. CONCLUSION It seems that, compared to open surgery alone when endovascular procedures were impossible, elective hybrid procedures are more secure and efficient in stable patients and could make the operation easier without more dissection for proximal control of splenic artery.
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Affiliation(s)
- Javad Salimi
- Department of Vascular Surgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran.
| | - Parham Nikraftar
- Department of Vascular Surgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Fatemeh Rashidi
- Department of Vascular Surgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Azimi
- School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amir Shokri
- Department of General Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Kulkarni S, Chakole S, Dubey T, Yelne S. A Rare Case of Splenic Artery Aneurysm With Unusual Combination of Pancytopenia and Massive Splenomegaly in a Tertiary Care Hospital. Cureus 2023; 15:e47940. [PMID: 38034136 PMCID: PMC10685079 DOI: 10.7759/cureus.47940] [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: 09/09/2023] [Accepted: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
Aneurysms of the splenic artery leading to extrahepatic portal hypertension are sporadic and infrequently encountered. They typically manifest as a consequence of thrombus or embolus formation. A splenic artery aneurysm (SAA) represents a localized expansion in the diameter of the splenic artery and is one of the most prevalent forms of visceral artery aneurysms. This artery dilation is primarily attributed to pancreatitis, trauma, or atherosclerosis, commonly affecting elderly patients. Patients affected by this condition typically remain asymptomatic, except for an audible bruit over the aneurysm site, unless a rupture occurs. In the event of a rupture, early indicators include abdominal pain, hemoperitoneum, and a positive Kerr sign, all indicative of SAA rupture. Most SAAs are incidentally discovered, with CT angiography being the preferred diagnostic tool. We present the case of a 38-year-old female (gravida 1, para 1) with a previous full-term normal delivery, who presented to a rural tertiary care hospital with a two-week history of left-sided abdominal pain. A CT scan of the abdomen revealed a solitary aneurysm in the distal portion of the splenic artery, accompanied by perisplenic fluid collection resulting in splenomegaly. Given the critical risk of rupture, which can result in life-threatening bleeding, prompt and accurate diagnosis assumes paramount significance. It is worth noting that the diagnosis of SAA often occurs incidentally due to its asymptomatic nature in its early stages. We document this unique occurrence of extrahepatic SAA contributing to pancytopenia, portal hypertension, and extensive splenomegaly to provide valuable insights for medical professionals in recognizing and managing such presentations. This awareness can help prevent unnecessary diagnostic and therapeutic interventions.
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Affiliation(s)
- Shrawani Kulkarni
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swarupa Chakole
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tanishq Dubey
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Seema Yelne
- Nursing, Shalinitai Meghe College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Pathak N, Poddar E, Shrestha S, Kumari K, Ranjan R, Sharma D, Dahal R, Lakhey PJ. Splenic artery aneurysm with extrahepatic portal venous obstruction: A case report. Int J Surg Case Rep 2022; 98:107568. [PMCID: PMC9468375 DOI: 10.1016/j.ijscr.2022.107568] [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: 07/27/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction and importance Case presentation Discussion Conclusion SAA with EHPVO is especially common during pregnancy. Albeit rare, due to its high risk of fatality, it is extremely important for clinicians to diagnose and manage it well. Surgery is the best modality of treatment for SAA with EHPVO with hypersplenism.
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Affiliation(s)
- Niharika Pathak
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
- Corresponding author.
| | - Elisha Poddar
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Suraj Shrestha
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Khusbu Kumari
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Ritika Ranjan
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Deepak Sharma
- Department of Surgical Gastroenterology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Romi Dahal
- Department of Surgical Gastroenterology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Paleswan Joshi Lakhey
- Department of Surgical Gastroenterology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Salimi J, Foroutani L, Miratashi Yazdi SA. Management of huge splenic artery aneurysm with new hybrid procedure including endovascular and open surgical approach: Case series. Int J Surg Case Rep 2021; 89:106585. [PMID: 34775324 PMCID: PMC8593227 DOI: 10.1016/j.ijscr.2021.106585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Splenic artery aneurysms (SAAs) account for more than half of all visceral artery aneurysms. Small SAAs are usually asymptomatic, but giant aneurysms are more likely to cause symptoms and result in life-threatening complications; these aneurysms treatment can be challenging. Splenic artery aneurysms treatment includes laparotomy, laparoscopy, or endovascular techniques. CASE PRESENTATION This case series reports the details of successful management of three patients with huge splenic artery aneurysms who underwent hybrid surgery, endovascular inflow control with a balloon, and open aneurysm resection. DISCUSSION Although endovascular treatment options are increasingly favored, only selected aneurysms are suitable for these procedures, as marked tortuosity of the artery or SAA in the proximal splenic artery may not be suitable for endovascular management. CONCLUSION Open surgery escorted by endovascular techniques can be considered an ideal treatment of SAA in the proximal region of the splenic artery.
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Affiliation(s)
- Javad Salimi
- Professor of Surgery, Vascular & Endovascular Surgeon, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Lale Foroutani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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8
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Successful endovascular embolization of a giant splenic artery pseudoaneurysm secondary to a huge pancreatic pseudocyst with concomitant spleen invasion. Pol J Radiol 2021; 86:e489-e495. [PMID: 34567295 PMCID: PMC8449560 DOI: 10.5114/pjr.2021.108876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/06/2020] [Indexed: 12/11/2022] Open
Abstract
Pseudoaneurysms of the pancreatic and peripancreatic arteries is a well-known complication of chronic or necrotizing pancreatitis due to proteolytic enzymatic digestion of the arterial wall. A major part of peripancreatic pseudoaneurysms involve the splenic artery, but any peripancreatic artery may be involved and bleed. They are potentially life threatening for patients, due to spontaneous intraperitoneal rupture, rupture and fistulization into the surrounding organs, or fistulization into the pancreatic duct. Small ones are usually asymptomatic and are often diagnosed incidentally, while giant (> 5 cm) aneurysms and pseudoaneurysms are symptomatic and may be detected as a pulsatile mass in the upper-left quadrant or epigastrium. Imaging plays a key role in the identification of splenic artery aneurysms and pseudoaneurysms, while angiography still represents the gold standard for the diagnosis, although nowadays it plays a prominent role in treatment. Treatment of splenic artery pseudoaneurysms is mandatory because of the high probability of rupture, with a mortality rate of up to 90%. The gold standard treatment is represented by surgery, with a mortality rate between 16% and 50%. In recent years the endovascular approach has proven to be an effective alternative treatment for splenic artery pseudoaneurysms, and it is currently the method of choice. In this article, we present the case of a ant pseudoaneurysm of the splenic artery due to huge pseudocysts in a young alcoholic patient with recurrent and chronic pancreatitis, complicated by fistulization and invasion of spleen parenchyma and arteriovenous fistula.
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9
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Mulpuri VB, Samanta J, Gupta P, Gupta V. En bloc resection in giant bilobed splenic artery aneurysm. BMJ Case Rep 2021; 14:e244319. [PMID: 34556530 PMCID: PMC8461702 DOI: 10.1136/bcr-2021-244319] [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] [Accepted: 08/26/2021] [Indexed: 12/29/2022] Open
Abstract
Giant splenic artery aneurysms are rare and associated with high morbidity and mortality. Early detection is the key to decreasing morbidity and mortality. We present a giant splenic artery aneurysm which was managed by en bloc resection of the spleen, distal pancreas.
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Affiliation(s)
- Venu Bhargava Mulpuri
- Surgical Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayanta Samanta
- Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Radiodiagnosis, Post Graduate Institute of Medical Education and Research College of Nursing, Chandigarh, India
| | - Vikas Gupta
- Surgical Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Haris AM, Singh JR, Raghuram C, Pradeep R, Reddy DN. Guidewires as Embolic Agents? Embolotherapy of Large Splenic Artery Aneurysms. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1728969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractSplenic artery aneurysms are among the more frequently diagnosed intra-abdominal aneurysms and are not infrequent in patients with raised portal venous pressure often requiring endovascular or surgical therapy. A 36-year-old female patient with Non-cirrhotic portal fibrosis and portal hypertension was diagnosed with multiple large splenic artery aneurysms for which she was initially operated which resulted in substantial blood loss during dissection that required embolotherapy. Initial attempts at coil embolization proved unsuccessful due to the wide aneurysmal neck and flow characteristics. Following which the aneurysmal sac was packed with multiple guidewires to act as a scaffold for further coil embolization. Subsequently, hemostasis was achieved and the patient underwent splenectomy later thereby demonstrating that embolization of large aneurysms can be accomplished with reasonable efficacy using guidewires.
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Affiliation(s)
- Arafat Muhammed Haris
- Department of Interventional Radiology, Asian Institute of Gastroenterology, Hyderabad, Telangana India
| | - Jagdeesh Rampal Singh
- Department of Interventional Radiology, Asian Institute of Gastroenterology, Hyderabad, Telangana India
| | - Chitterusu Raghuram
- Department of Gastro-Intestinal Surgery, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Rebala Pradeep
- Department of Gastro-Intestinal Surgery, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - D. Nageshwar Reddy
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
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11
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Fatal rupture of giant splenic artery pseudoaneurysm. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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12
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Cirsoid aneurysm rupture of the splenic artery as a rare cause of fatal hemoperitoneum. J Forensic Leg Med 2021; 79:102134. [PMID: 33636647 DOI: 10.1016/j.jflm.2021.102134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/10/2021] [Accepted: 02/14/2021] [Indexed: 01/28/2023]
Abstract
Cirsoid aneurysms are rare arteriovenous malformations without any capillaries interposed and almost always observed in the scalp region. These types of aneurysms are so-called "cirsoid" because of their serpiginous appearance. In this report, the authors present the first case of a lethal spontaneous rupture of a cirsoid aneurysm of the splenic artery, which could be diagnosed only by post-mortem histologic examination. The victim was a 70-year-old man who was suddenly found dead in bed while he was hospitalized and waiting for a scheduled cardiac surgery. A forensic autopsy was ordered due to the suspicion that the man's death could have been related to medical malpractice. An accurate autopsy and a complete forensic histologic examination could clarify the cause of death, which was identified in the spontaneous rupture of a cirsoid aneurysm of the splenic artery. The case is intended to be used as source data for similar forensic cases, where the cause of a massive hemoperitoneum is difficult to be identified.
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Abstract
Endovascular management of small visceral artery aneurysms is an established treatment with satisfactory outcomes. However, when size exceeds 5 cm visceral aneurysms are considered as “giant” (giant visceral artery aneurysms or GVAAs) and management is significantly more complex. Between August 2007 and June 2019 eleven cases of GVAAs that were endovascularly treated were retrospectively reviewed and included in this single center study. Mean size was 80 mm (± 26.3 mm) x 46 mm (+ \-11.8 mm). Nine of the lesions were true aneurysms, and two were pseudoaneurysms. In 8 patients, the lesion was causing compression symptoms in the surrounding organs, one patient developed a contained rupture while 2 patients were completely asymptomatic. However, all patients were hemodynamically stable at the time of treatment. Technical success was defined as immediate complete exclusion of the aneurysmal sac, and clinical success as complete relief from clinical symptoms. Follow-up was performed with CT angiography, ultrasound and clinical examination. Mean follow-up was 45 months (range 6–84). Technical and clinical success were both 91%. Complications were one lack of control of contained rupture that was subsequently operated, one case of self-limiting non-target spleen embolization and one case of splenic abscess. Three patients died, one due to the contained rupture 15 days after procedure, the other two for other causes and occurred during the long-term follow-up. This series suggests that endovascular treatment of giant visceral artery aneurysms and pseudoaneuryms is a valid minimally invasive solution with very satisfactory immediate and long-term outcomes unless the aneurysm is already ruptured. A variety of endovascular tools may be required for successful treatment.
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14
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Charchyan E, Stepanenko A, Abugov S, Polyakov R, Ivanova A, Gens A. Surgical and endovascular treatment of splenic artery aneurysm. KARDIOLOGIYA I SERDECHNO-SOSUDISTAYA KHIRURGIYA 2021; 14:185. [DOI: 10.17116/kardio202114031185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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15
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Lim HJ. A review of management options for splenic artery aneurysms and pseudoaneurysms. Ann Med Surg (Lond) 2020; 59:48-52. [PMID: 32983447 PMCID: PMC7498731 DOI: 10.1016/j.amsu.2020.08.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/26/2020] [Accepted: 08/30/2020] [Indexed: 11/15/2022] Open
Abstract
Background A review of the management of splenic artery aneurysms (SAA). There is no general consensus as to when and what type of intervention should be chosen to treat SAAs. The aim of this study is to investigate the types of intervention for SAAs including complication, reintervention, rupture, mortality after intervention of SAA in a review. Method A literature search was performed using "keywords" in Medline and Embase limited to publications from 2008 to 2018. 289 articles were identified during the initial literature search. 143 articles met the eligibility criteria. 83 articles were included in the quantitative synthesis. Descriptive analysis was performed. Results 576 patients were identified with 588 reported SAAs. The mean ± SD age was 52.6 ± 5.8 years (range 17-85). The mean ± SD size of SAA was 49.9 ± 13.2 mm (range 6-180). Types of intervention reported were endovascular treatment, open surgery, laparoscopic surgery and conservative management. Mortality rate in patients with endovascular treatment was 0.5% compared to 4.9% with open surgery. 3.4% of patients with conservative management were reported to have aneurysms that grew over time and 2.8% patients had further intervention. ANOVA test to compare mortality between open surgery, endovascular treatment and laparoscopic surgery showed there is no difference between mortality between the 3 different interventions as F (2.71) < F crit (3.02) (P = 0.07). Conclusion Endovascular treatment is now the first choice of treatment for SAA, but future studies are required to determine its long-term durability. By introducing a management pathway for SAA, we hope to see an improvement in managing patients. The management algorithm will require further validation through application with careful and complete follow-up of all cases to improve the pathway depending on patient outcome.
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16
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Leung E, Maingard J, Yeh J, Lee MJ, Brooks DM, Asadi H, Burrows DA, Kok HK. Contemporary endovascular management of splenic vascular pathologies. Clin Radiol 2020; 75:960.e23-960.e34. [PMID: 32819705 DOI: 10.1016/j.crad.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
Abstract
The spleen is a commonly injured organ and the splenic vasculature is also susceptible to inflammation and trauma, often resulting in aneurysm formation. Splenic artery aneurysms carry a high risk of rupture and are associated with high mortality and morbidity. Due to the advances in endovascular techniques and devices, endovascular management of splenic vascular pathologies is now considered a first-line strategy. Endovascular embolisation and advance techniques including balloon- or stent-assisted coil embolisation enables minimally invasive management option while preserving splenic function.
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Affiliation(s)
- E Leung
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia.
| | - J Maingard
- Interventional Neuroradiology Service - Monash Imaging, Monash Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - J Yeh
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia
| | - M J Lee
- Department of Radiology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D M Brooks
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia; Interventional Neuroradiology Service - Radiology Department, Austin Hospital, Melbourne, Australia
| | - H Asadi
- Interventional Neuroradiology Service - Monash Imaging, Monash Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia; Interventional Neuroradiology Service - Radiology Department, Austin Hospital, Melbourne, Australia
| | - D A Burrows
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia
| | - H K Kok
- Interventional Radiology Service - Department of Radiology, Northern Health, Melbourne, Australia; School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
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Hamid HKS, Suliman AEA, Piffaretti G, Spiliopoulos S, Tetreau R, Tozzi M, Pulli R. A systematic review on clinical features and management of true giant splenic artery aneurysms. J Vasc Surg 2020; 71:1036-1045.e1. [PMID: 31727456 DOI: 10.1016/j.jvs.2019.09.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/16/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND True giant splenic artery aneurysms (GSAAs) >5 cm are rare and present unique therapeutic challenges. The aim of this study was to evaluate the anatomic and clinical characteristics of these lesions and the current surgical and endovascular techniques available for their treatment. METHODS A systematic review of the literature from 2004 to 2018 and the personal experience of the authors with management of GSAAs are presented. A total of 92 GSAA cases were reviewed. Analyses were performed on anatomic and clinical features and management modalities and outcomes of GSAA, including reintervention, morbidity, and mortality. RESULTS GSAA presented at a mean age of 56.1 ± 17.3 years, with no sex predilection; 73% were symptomatic at presentation. Abdominal pain was the presenting symptom in >50% of cases; 34% percent were ruptured, with an overall mortality rate of 12.5%. This group often presented with gastrointestinal bleeding or hemodynamic collapse. The aneurysms were almost evenly distributed across the splenic artery and were not uncommonly associated with arteriovenous fistula formation (8.7%). There were 88 patients who had surgical (53.4%), endovascular (44.3%), or combination (2.3%) therapy. The most commonly performed procedure was aneurysmectomy and splenectomy with or without additional resection. Overall, surgical treatment had a lower morbidity (P = .041) than endovascular therapy and comparable reintervention and mortality rates. CONCLUSIONS GSAAs are uncommon vascular lesions, with distinct clinical features and aneurysm characteristics. Considering their high risk of rupture, timely diagnosis and management are essential to attain a satisfactory outcome. Surgery remains the standard treatment of these lesions. Endovascular intervention is a viable alternative in high-risk patients, particularly those with lesions <10 cm or with anomalous origin.
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Affiliation(s)
- Hytham K S Hamid
- Vascular Surgery Division, Department of Surgery, Soba University Hospital, Khartoum, Sudan.
| | - Abd Elaziz A Suliman
- Vascular Surgery Division, Department of Surgery, Soba University Hospital, Khartoum, Sudan
| | - Gabriele Piffaretti
- Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Stavros Spiliopoulos
- Department of Diagnostic and Interventional Radiology, Patras University Hospital, Rion, Greece
| | - Raphael Tetreau
- Centre d'Imagerie Médicale, Institut du Cancer, Montpellier, France
| | - Matteo Tozzi
- Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Raffaelle Pulli
- Vascular and Endovascular Surgery Unit, University of Bari, Bari, Italy
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Wang W, Chang H, Liu B, Wang W, Yu Z, Chen C, Li Y, Wang Z, Wang Y. Long-term outcomes of elective transcatheter dense coil embolization for splenic artery aneurysms: a two-center experience. J Int Med Res 2019; 48:300060519873256. [PMID: 31510827 PMCID: PMC7262844 DOI: 10.1177/0300060519873256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objective This study was performed to analyze the long-term follow-up safety and efficacy of transcatheter dense coil embolization for splenic artery aneurysms. Methods Thirty-two patients (18 women, 14 men; age range, 23–56 years; mean age, 43.1 ± 13.6 years) who underwent dense coil embolization for treatment of splenic artery aneurysms from August 2010 to January 2018 were retrospectively reviewed. The size and location of the splenic artery aneurysms, the technical and clinical outcomes of the procedure, and the complications related to the procedure were reviewed. Results The technical success rate of embolization was 100% (mean aneurysm size, 29.4 ± 6.9 mm; range, 20–43 mm). Two (6.3%) patients underwent a successful repeat intervention procedure for recurrent aneurysm perfusion during follow-up (mean, 36 months; range, 6–72 months). No aneurysm ruptured during follow-up. Splenic infarction was observed in 8 of 32 (25%) patients. No patients developed major adverse events related to the procedure, such as splenic abscess or pancreatitis. Conclusions Percutaneous elective transcatheter dense coil embolization is safe and effective to prevent aneurysm rupture and overcome aneurysm recanalization during long-term follow-up.
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Affiliation(s)
- Wujie Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Haiyang Chang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Bin Liu
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Wei Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Zhe Yu
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Chao Chen
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
| | - Zhenting Wang
- Medical Imaging Institute of Shandong Province, Jinan City, Shandong Province, China
| | - Yongzheng Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, China
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Niu H, Junfeng S, Jianli A, Zibo Z, Yanchao D. Dual-interventional therapy for multiple splenic artery aneurysms in a patient with portal hypertension: A case report. Medicine (Baltimore) 2019; 98:e15205. [PMID: 31083153 PMCID: PMC6531276 DOI: 10.1097/md.0000000000015205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
RATIONALE Portal hypertension (PHT) is either a significant risk factor of development of splenic artery aneurysm (SAA), or predisposing factor of rupture. PATIENT CONCERNS A 57-year-old patient was admitted to our hospital because of multiple SAAs with PHT, suffered from episodes of haematemesis. DIAGNOSIS Emergency ultrasound of the abdomen showed remarkable cirrhosis and splenomegaly. Two days later, CT angiography reveal two SAA located in the splenic artery, as well as splenomegaly and features of PHT. INTERVENTIONS Transjugular intrahepatic portosystemic shunt (TIPS) was performed to decrease portal venous pressure and control esophagogastric variceal hemorrhage. Coil embolization of the main splenic artery was performed to complete thrombosis of the two SAAs and relieve critical hypersplenism. OUTCOMES After 3 months, follow-up enhanced CT confirmed complete thrombosis of the main splenic artery and the two aneurysm sac, and partial splenic infarction (approximately 50%). LESSENS TIPS can control easophagogastric variceal hemorrhage and decrease portal venous pressure, coil embolization of the main splenic artery can promote permanent thrombosis of aneurysm sac and relieve hypersplenism.
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Tani R, Hori T, Yamamoto H, Harada H, Yamamoto M, Yamada M, Yazawa T, Tani M, Kamada Y, Aoyama R, Sasaki Y, Zaima M. Severely Calcified True Aneurysm: A Thought-Provoking Case of Solitary Origin and Postoperative Management. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:620-627. [PMID: 31031402 PMCID: PMC6501733 DOI: 10.12659/ajcr.915010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 02/28/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Visceral arterial aneurysms are rare. Most splenic arterial aneurysms (SAAs) are saccular and are in the distal third of the splenic artery. Suggested major causes of SAAs are atherosclerosis, pregnancy, and inflammation. We report the case of a patient who with a SAA extending almost the full length of his splenic artery. CASE REPORT A solitary true aneurysm that extended almost the entire length of the splenic artery was incidentally detected in an asymptomatic 70-year-old male patient with a history of myasthenia gravis and diabetes mellitus. His SAA was severely calcified, but other arteries showed no calcification. The aneurysm had been slightly enlarged toward the celiac artery for 2 years, and aneurysmectomy and splenectomy were performed. Vascular clips were carefully placed at the intact splenic artery without disturbing arterial flows from the celiac artery. Arterial branch from the SAA was ligated at an intact area, and the pancreatic capsule was densely adherent with the calcified aneurysm wall. The pancreas was preserved, although the pancreatic parenchyma was widely exposed during aneurysmectomy. Pathological examination revealed no atherosclerotic changes. Postoperatively, a pancreatic fistula developed, which was treated by placing an intraperitoneal drain and retrograde pancreatic drainage tube. Nevertheless, the intractable pancreatic fistula triggered a bacteriogenic infection, resulting in intraperitoneal abscess. Continuous local lavage via transnasal continuous infusion and endoscopic transgastric drainage was performed, until the fistula closed. He was healthy at 9 months after surgery. CONCLUSIONS A SAA that had the rare form and solitary origin was treated. Continuous local lavage has a therapeutic potential for a pancreatic juice-related bacteriogenic complication.
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BACALBASA NICOLAE, BALESCU IRINA, TANASE ALINA, PAUTOV MIHAI, BREZEAN IULIAN, VILCU MIHAELA, BRASOVEANU VLADISLAV. Spleno-pancreatectomy En Bloc with Parcelar Gastrectomy for Splenic Artery Aneurysm - A Case Report and Literature Review. In Vivo 2018; 32. [PMID: 29936480 PMCID: PMC6117755 DOI: 10.21873/invivo.112329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Splenic artery aneurysms are common arterial lesions which might remain asymptomatic for a long period of time. In certain cases, these lesions might encounter a significant growth and might become symptomatic. Once diagnosed, a therapeutic strategy should be taken in consideration in order to avoid the apparition of life-threatening complications such as aneurysmal rupture. This is a case report of a 45-year-old patient diagnosed with a splenic artery aneurysm who was successfully submitted to an aneurysmal resection en bloc with distal spleno-pancreatectomy and parcelar gastrectomy.
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Affiliation(s)
- NICOLAE BACALBASA
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | | | - ALINA TANASE
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - MIHAI PAUTOV
- “Dan Setlacec” Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - IULIAN BREZEAN
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,“I. Cantacuzino” Clinical Hospital, Bucharest, Romania
| | - MIHAELA VILCU
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,“I. Cantacuzino” Clinical Hospital, Bucharest, Romania
| | - VLADISLAV BRASOVEANU
- “Dan Setlacec” Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
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Bacalbasa N, Balescu I, Tanase A, Pautov M, Brezean I, Vilcu M, Brasoveanu V. Spleno-pancreatectomy En Bloc with Parcelar Gastrectomy for Splenic Artery Aneurysm - A Case Report and Literature Review. In Vivo 2018; 32:915-919. [PMID: 29936480 DOI: 10.21873/invivo.11329] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 02/07/2023]
Abstract
Splenic artery aneurysms are common arterial lesions which might remain asymptomatic for a long period of time. In certain cases, these lesions might encounter a significant growth and might become symptomatic. Once diagnosed, a therapeutic strategy should be taken in consideration in order to avoid the apparition of life-threatening complications such as aneurysmal rupture. This is a case report of a 45-year-old patient diagnosed with a splenic artery aneurysm who was successfully submitted to an aneurysmal resection en bloc with distal spleno-pancreatectomy and parcelar gastrectomy.
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Affiliation(s)
- Nicolae Bacalbasa
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Alina Tanase
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Mihai Pautov
- "Dan Setlacec" Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Iulian Brezean
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "I. Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - Mihaela Vilcu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "I. Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - Vladislav Brasoveanu
- "Dan Setlacec" Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
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Kauffman P, Macedo ALDV, Sacilotto R, Tachibana A, Kuzniec S, Pinheiro LL, Wolosker N. The therapeutic challenge of giant splenic artery aneurysm: a case repport. EINSTEIN-SAO PAULO 2017; 15:359-362. [PMID: 28746591 PMCID: PMC5823053 DOI: 10.1590/s1679-45082017rc3873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 01/13/2017] [Indexed: 11/21/2022] Open
Abstract
Giant splenic artery aneurysm is a rare condition that represents an eminent life threatening for the patient, requiring, therefore, urgent surgical correction. A 61-year-old woman, former smoker, hypertensive, hypercholesterolemic and multipara sought our service because of a large tumor in the mesogastrium, which was an abdominal ultrasound finding. Despite the size of the tumor, the patient was asymptomatic. The angiotomography and the magnetic resonance image of the abdomen were suggestive of giant splenic artery aneurysm with more than 10cm in diameter that was confirmed by an angiography. She underwent surgery, open splenectomy, and partial aneurysmectomy. The approach of the celiac artery, which was ligated, was only possible with medialvisceral rotation because there was no possibility to view it through the anterior access. The histopathological test of aneurysmatic wall revealed atheroma plaques in the intima. The patient progressed without complications and she was discharged cured. In general, giant splenic artery aneurysms are symptomatic, however, as in the case we report, it may be asymptomatic and found in abdominal imaging exam. Although less invasive Interventional methods exist, such as laparoscopy and endovascular techniques, they were considered inappropriate in this case. Conventional open surgery should be the therapy of choice for a giant splenic artery aneurysm.
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Affiliation(s)
- Paulo Kauffman
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Roberto Sacilotto
- Hospital do Servidor Público Estadual "Francisco Morato de Oliveira", São Paulo, SP, Brazil
| | | | - Sergio Kuzniec
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Malekpour Alamdari N, Massoudi N, Asgarpour H. Endovascular Therapy for Splenic Artery Aneurysm: A Case Report. IRANIAN RED CRESCENT MEDICAL JOURNAL 2017; 19. [DOI: 10.5812/ircmj.13952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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25
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Creidi E, El Asmar A, Abou Zahr R, El Rassi Z. Giant splenic artery aneurysm in a pregnant patient: a case report and literature review. Clin Case Rep 2017; 5:1132-1135. [PMID: 28680611 PMCID: PMC5494404 DOI: 10.1002/ccr3.1000] [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: 07/25/2016] [Revised: 02/02/2017] [Accepted: 04/14/2017] [Indexed: 12/01/2022] Open
Abstract
Pregnancy and giant splenic artery aneurysms should be addressed in a way to achieve optimal results for the mother and the fetus. In our case, the need for immediate intervention, with minimal risk, made open aneurysmectomy and distal splenopancreatectomy, the ideal approach to undertake.
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Affiliation(s)
- Elie Creidi
- General Surgery Resident Saint Georges Hospital University Medical Center,Beirut Lebanon.,Faculty of MedicineUniversity of BalamandBeirutLebanon
| | - Antoine El Asmar
- General Surgery Resident Saint Georges Hospital University Medical Center,Beirut Lebanon.,Faculty of MedicineUniversity of BalamandBeirutLebanon
| | - Rawad Abou Zahr
- Faculty of MedicineUniversity of BalamandBeirutLebanon.,Urology Resident Saint Georges Hospital University Medical Center Beirut Lebanon
| | - Ziad El Rassi
- Faculty of MedicineUniversity of BalamandBeirutLebanon.,Department of Clinical Surgery General and Digestive Surgery - Oncologic Surgery Saint Georges Hospital University Medical Center Beirut Lebanon
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Khan A, Ayub M, Haider I, Humayun M, Shah Z, Ajmal F. Coexisting giant splenic artery and portal vein aneurysms leading to non-cirrhotic portal hypertension: a case report. J Med Case Rep 2016; 10:270. [PMID: 27686495 PMCID: PMC5043529 DOI: 10.1186/s13256-016-1059-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Splenic artery aneurysms are the commonest visceral and third most common abdominal artery aneurysms, having a strong association with both pregnancy and multiparity. Here we report possibly the first case of a giant splenic artery aneurysm in association with a smaller portal vein aneurysm, in a woman who had never conceived, leading to non-cirrhotic portal hypertension. CASE PRESENTATION A 40-year-old Pakistani Asian woman who had no evidence of liver cirrhosis presented in April 2016 for a diagnostic workup of ascites, massive splenomegaly, and pancytopenia. An abdominal ultrasound followed by computed tomography angiography showed a giant aneurysm in her splenic artery and another smaller one in her portal vein. She underwent splenectomy and excision of the splenic artery aneurysm. Surgical findings included a giant splenic artery aneurysm pressing on her portal vein and causing its aneurysmal dilatation. On her first review in July 2016, she was generally in good health, ascites had subsided, and her full blood count was normal. Her portal vein aneurysmal dilatation, which was presumed to be secondary to the pressure effect from the splenic artery aneurysm, had shrunken remarkably in size. CONCLUSION A giant splenic artery aneurysm can cause non-cirrhotic portal hypertension and should be treated with splenectomy and aneurysmectomy.
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Affiliation(s)
- Abidullah Khan
- Resident Internal Medicine, Khyber Teaching Hospital, 25000, Peshawar, Pakistan.
| | - Maimoona Ayub
- Resident Internal Medicine, Khyber Teaching Hospital, 25000, Peshawar, Pakistan
| | - Iqbal Haider
- Resident Internal Medicine, Khyber Teaching Hospital, 25000, Peshawar, Pakistan
| | - Mohammad Humayun
- Resident Internal Medicine, Khyber Teaching Hospital, 25000, Peshawar, Pakistan
| | - Zakir Shah
- Resident Internal Medicine, Khyber Teaching Hospital, 25000, Peshawar, Pakistan
| | - Fahad Ajmal
- Resident Internal Medicine, Khyber Teaching Hospital, 25000, Peshawar, Pakistan
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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: 8] [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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Multiple Giant Splenic Artery Aneurysms Causing Sinistral (Left-Sided) Portal Hypertension. Case Rep Gastrointest Med 2016; 2016:6278452. [PMID: 27110411 PMCID: PMC4826675 DOI: 10.1155/2016/6278452] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/08/2016] [Accepted: 03/16/2016] [Indexed: 12/24/2022] Open
Abstract
Background. Splenic artery aneurysm is the most common type of visceral aneurysms. They are usually asymptomatic and have a potential for rupture and therefore life-threatening hemorrhage. It is rare for them to cause sinistral portal hypertension. Case Report. A 23-year-old female patient presented to our clinic with gastric varices, splenomegaly, pancytopenia, and normal liver functions. She was thus diagnosed with left-sided portal hypertension. Radiologic evaluation showed splenomegaly, splenic vein obstruction, and multiple aneurysms along the splenic artery ranging from 2.5 cm to 7 cm. Splenic artery aneurysm was thought to be the cause of portal hypertension and hypersplenism. We decided splenectomy is the best course of treatment. Pancytopenia could not be corrected preoperatively despite the transfusion treatment. Surgical exploration revealed multiple aneurysms deeply embedded in pancreas. Thrombocyte and erythrocyte transfusion was performed after splenic artery ligation to correct pancytopenia before further intervention. Splenic artery, spleen, and distal pancreas were resected en bloc. Patient's blood parameters became normal within first postoperative day. Patient had an uneventful postoperative course and was discharged without incident. Conclusion. Splenic artery aneurysms are rare but potentially life-threatening incidents. Therefore, it is important to know the unusual presentations and prepare accordingly.
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Barišić T, Šutalo N, Letica L, Kordić AV. Rupture of splenic artery aneurysm in primipara five days after cesarean section: case report and review of the literature. Wien Klin Wochenschr 2015; 127:896-898. [PMID: 26373746 DOI: 10.1007/s00508-015-0856-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 08/19/2015] [Indexed: 11/28/2022]
Abstract
Splenic artery aneurysm (SAA) is a rare and usually asymptomatic vascular anomaly which carries the risk of rupture and fatal hemorrhage. It is more common in women and is usually associated with pregnancy. We present the case of rupture of SAA, 5 days after giving birth by cesarean section, which was diagnosed with Multi-Slice Computed Tomografy (MSCT) angiography and was successfully operated in the second emergency laparotomy, with the final good outcome for the mother. This case indicates that in case of sudden bleeding in the abdomen, with the development of hypovolemic shock, especially in the peripartum period, should be suspected rupture of SAA. The paper presents a critical review of this case, with a review of the literature.
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Affiliation(s)
- Tatjana Barišić
- Department of Obstetrics and Gynecology, University Clinical Hospital Mostar, Bijeli brijeg B.B., 88000, Mostar, Bosnia and Herzegovina.
| | - Nikica Šutalo
- Department of Chirurgy, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Ludvig Letica
- Department of Chirurgy, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Andrea Vladimira Kordić
- Department of Radiology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
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Yagmur Y, Akbulut S, Gumus S, Demircan F. Giant Splenic Artery Pseudoaneurysm: A Case Report and Literature Review. Int Surg 2015; 100:1244-1248. [PMID: 26595501 DOI: 10.9738/intsurg-d-15-00043.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Splenic artery aneurysms (SAAs) are the third most frequent intra-abdominal aneurysm, following abdominal aorta and iliac artery aneurysms. SAAs are classified according to their involvement of arterial wall layers: true aneurysms involve all 3 layers (intima, media, and adventitia), and pseudoaneurysms involve only one or two. Herein we present a new case of giant pseudo SAA. A 65-year-old female patient with a pancreatic mass and iron deficiency was referred to our clinic for further investigation. Abdominal ultrasonography, contrast-enhanced CT and magnetic resonance imaging showed a lesion resembling a subcapsular hemangioma in the spleen, and aneurysmatic dilation of the splenic artery with a diameter of >5 cm. The large size of the aneurysm and the clinical findings were indications for surgical treatment. The patient underwent en bloc resection of the spleen, distal pancreas, and aneurysmatic segment of the splenic artery. The patient remains complication-free 2 months after the operation. Spontaneous rupture is the most important life-threatening complications of giant SAAs. Therefore, all symptomatic patients with SAA should be treated, as well as asymptomatic patients with lesions ≥2 cm, who are pregnant or fertile, have portal hypertension, or are candidates for liver transplantation. Despite advances in endovascular techniques, conventional abdominal surgery remains the gold standard for treatment.
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Affiliation(s)
- Yusuf Yagmur
- 1 Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
| | - Sami Akbulut
- 2 Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Serdar Gumus
- 1 Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
| | - Firat Demircan
- 1 Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
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Akbulut S, Otan E. Management of Giant Splenic Artery Aneurysm: Comprehensive Literature Review. Medicine (Baltimore) 2015; 94:e1016. [PMID: 26166071 PMCID: PMC4504560 DOI: 10.1097/md.0000000000001016] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/01/2015] [Accepted: 05/22/2015] [Indexed: 02/07/2023] Open
Abstract
To provide an overview of the medical literature on giant splenic artery aneurysm (SAA).The PubMed, Medline, Google Scholar, and Google databases were searched using keywords to identify articles related to SAA. Keywords used were splenic artery aneurysm, giant splenic artery aneuryms, huge splenic artery aneurysm, splenic artery aneurysm rupture, and visceral artery aneurysm. SAAs with a diameter ≥5 cm are considered as giant and included in this study. The language of the publication was not a limitation criterion, and publications dated before January 15, 2015 were considered.The literature review included 69 papers (62 fulltext, 6 abstract, 1 nonavailable) on giant SAA. A sum of 78 patients (50 males, 28 females) involved in the study with an age range of 27-87 years (mean ± SD: 55.8 ± 14.0 years). Age range for male was 30-87 (mean ± SD: 57.5 ± 12.0 years) and for female was 27-84 (mean ± SD: 52.7 ± 16.6 years). Most frequent predisposing factors were acute or chronic pancreatitis, atherosclerosis, hypertension, and cirrhosis. Aneurysm dimensions were obtained for 77 patients with a range of 50-300 mm (mean ± SD: 97.1 ± 46.0 mm). Aneurysm dimension range for females was 50-210 mm (mean ± SD: 97.5 ± 40.2 mm) and for males was 50-300 mm (mean ± SD: 96.9 ± 48.9 mm). Intraperitoneal/retroperitoneal rupture was present in 15, among which with a lesion dimension range of 50-180 mm (mean ± SD; 100 ± 49.3 mm) which was range of 50-300 mm (mean ± SD: 96.3 ± 45.2 mm) in cases without rupture. Mortality for rupture patients was 33.3%. Other frequent complications were gastrosplenic fistula (n = 3), colosplenic fistula (n = 1), pancreatic fistula (n = 1), splenic arteriovenous fistula (n = 3), and portosplenic fistula (n = 1). Eight of the patients died in early postoperative period while 67 survived. Survival status of the remaining 3 patients is unclear. Range of follow-up period for the surviving patients varies from 3 weeks to 42 months.Either rupture or fistulization into hollow organs risk increase in compliance with aneurysm diameter. Mortality is significantly high in rupture cases. Patients with an evident risk should undergo either surgical or interventional radiological treatment without delay.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
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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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Aneurysm resection and vascular reconstruction for true aneurysm at the initial segment of splenic artery. ACTA ACUST UNITED AC 2015; 35:439-444. [PMID: 26072086 DOI: 10.1007/s11596-015-1450-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 04/24/2015] [Indexed: 12/24/2022]
Abstract
The aneurysms at the initial segment of splenic artery are rare. This paper aimed to investigate the methods to treat the true aneurysm at the initial segment of splenic artery by aneurysmectomy plus vascular reconstruction. Retrospectively reviewed were 11 cases of true aneurysm at the initial segment of splenic artery who were treated in our hospital from January 2000 to June 2013. All cases were diagnosed by color ultrasonography, computer tomography (CT) and angiography. Upon resection of the aneurysm, the auto-vein transplantation was performed in situ between the hepatic artery and the distal part of the splenic artery in 1 case; the artificial vessel bypass was done between the infra-renal aorta and distal portion of the splenic artery in 7 cases; the splenectomy was done in 2 cases; the splenectomy in combination with ligation of multiple small aneurysms were performed in 1 case. All cases were cured and discharged from the hospital 10-14 days after operation. A 1-14 year follow-up showed that 9 cases survived, and 2 cases died, including 1 case who died of acute myocardial infarction 2 years after aorta-splenic artery bypass operation and 1 case who died of acute cerebral hemorrhage 5 years after aneurysm resection and the splenectomy. Among 6 cases receiving aorta-splenic artery bypass, 1 gradually developed stenosis at anatomosed site, which eventually progressed to complete occlusion 2 years to 6 years after operation, without suffering from splenic infarction because the spleen was supplied by the short gastric vessel and its collaterals. The other 5 cases receiving aorta-splenic artery bypass and 1 case undergoing autologous vascular transplantation did not develop stricture or pseudoaneurysm at the stoma. Our study showed that the aneurysmectomy plus vascular reconstruction is a better treatment for aneurysm at the initial segment of splenic artery.
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Telfah MM. Splenic artery aneurysm: pre-rupture diagnosis is life saving. BMJ Case Rep 2014; 2014:bcr-2014-205115. [PMID: 25427929 DOI: 10.1136/bcr-2014-205115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Aroor AR, Prakasha S R, U R, Attar NR. Multiple splenic artery aneurysms: a rare cause of extrahepatic portal hypertension and massive splenomegaly. J Clin Diagn Res 2014; 8:MD01-2. [PMID: 25386475 DOI: 10.7860/jcdr/2014/8498.4821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 05/06/2014] [Indexed: 11/24/2022]
Abstract
A 39-year-old nulliparous female was admitted with massive splenomegaly. Computed tomography of abdomen revealed multiple aneurysms in the distal half of the splenic artery. Splenic artery aneurysms are rare in nulliparous women and most cases are reported in females with a past history of pregnancy. Splenic artery aneurysms, though very rare are clinically significant as they have a high propensity for fatal rupture. Here, we report a patient with multiple splenic artery aneurysms presenting as extrahepatic portal hypertension and massive splenomegaly.
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Affiliation(s)
- Akshatha Rao Aroor
- Associate Professor, Department of Medicine, K.S.Hegde Medical Academy , Mangalore, Karnataka, India
| | - Rama Prakasha S
- Assistant Professor, Department of Emergency Medicine, JIPMER , Puducherry, India
| | - Raghuraj U
- Associate Professor, Department of Radiodiagnosis, K.S.Hegde Medical Academy , Mangalore, Karnataka, India
| | - Nazir Rahim Attar
- Professor, Department of Medicine, K.S.Hegde Medical Academy , Mangalore, Karnataka, India
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Zeren S, Bayhan Z, Sönmez Y, Mestan M, Korkmaz M, Kadıoglu E, Ucar BI, Devir C, Ekici FM, Sanal B. Spontaneous splenic artery aneurysm rupture: mimicking acute myocardial infarct. Am J Emerg Med 2014; 32:1563.e1-3. [PMID: 25156976 DOI: 10.1016/j.ajem.2014.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 07/19/2014] [Indexed: 11/24/2022] Open
Abstract
Spontaneous splenic artery aneurysm (SAA) is a rare but a life-threatening condition. Thus, early diagnoses may increase the chance of survival. A 52-year-old female patient was admitted to the emergency department with a pain that starts from the chest and epigastric region and radiates to back and left arm. The patient prediagnosed as having acute myocardial infarct and was under observation when acute abdomen and hemorrhagic shock developed. After further investigation, the patient was diagnosed as having SAA and has undergone a successful surgery. The patient was fully cured and discharged from the hospital on the seventh postoperative day. The patient originally presented with SAA, although she was primarily observed in the emergency department with acute myocardial infarct diagnosis because of similar symptoms and clinical findings to cardiovascular diseases. When changes in the clinical picture occurred, the patient was reevaluated and had undergone an operation because of SAA rupture. Therefore, physicians should take into consideration of aneurysm rupture in the differential diagnosis of the cardiovascular conditions; otherwise, the patient may lose his/her life.
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Affiliation(s)
- Sezgin Zeren
- Department of General Surgery, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey.
| | - Zülfü Bayhan
- Department of General Surgery, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey
| | - Yalcın Sönmez
- Department of General Surgery, Evliya Celebi Training and Research Hospital, Kutahya, Turkey
| | - Metin Mestan
- Department of General Surgery, Evliya Celebi Training and Research Hospital, Kutahya, Turkey
| | - Mehmet Korkmaz
- Department of Radiology, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey
| | - Emine Kadıoglu
- Department of Emergency Medicine, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey
| | - Bercis Imge Ucar
- Department of General Surgery, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey
| | - Cigdem Devir
- Department of Radiology, Evliya Celebi Training and Research Hospital, Kutahya, Turkey
| | - Fatih Mehmet Ekici
- Department of General Surgery, Evliya Celebi Training and Research Hospital, Kutahya, Turkey
| | - Bekir Sanal
- Department of Radiology, Faculty of Medicine, Dumlupinar University, Kutahya, Turkey
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