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Mirande MH, Souza DLS, Thibodeaux L, Sutphin C. Spontaneous rupture of a mycotic splenic artery pseudoaneurysm secondary to histoplasmosis: a case report. Surg Case Rep 2024; 10:136. [PMID: 38829447 PMCID: PMC11147961 DOI: 10.1186/s40792-024-01920-y] [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: 02/22/2024] [Accepted: 05/03/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND A splenic artery pseudoaneurysm is a rare pathology that occurs mainly secondary to pancreatitis, abdominal trauma, peptic ulcers, pancreatic and gastric cancers, and infections. It is best diagnosed using computed tomography angiography and typically treated using endovascular embolization and, in some cases, open or laparoscopic surgery. In this report, we present a case of a ruptured mycotic splenic artery pseudoaneurysm containing Histoplasma capsulatum, which to our knowledge is the first case to report a mycotic splenic artery pseudoaneurysm of this nature. CASE PRESENTATION We report a case of a 42-year-old white male with past medical history of Hepatitis C and IV drug abuse who presented to the Emergency Department with a 24-h history of severe diffuse abdominal pain. He was tachycardic and peritonitic on exam. Work-up demonstrated leukocytosis and lactic acidosis. Computed tomography of the abdomen and pelvis with intravenous contrast showed hemoperitoneum and active extravasation of contrast from the splenic artery into the splenic hilum, associated with a surrounding hematoma measuring 5.3 × 5.0 cm, concerning for ruptured splenic artery pseudoaneurysm. The patient was taken emergently for exploratory laparotomy, where a large intraperitoneal hematoma was evacuated. A ruptured splenic artery pseudoaneurysm was identified, isolated, and controlled, followed by completion splenectomy. Final pathology demonstrated a 3.0 × 1.3 × 0.3 cm pseudoaneurysm wall and a 14 × 9.5 × 5.5 cm spleen containing multiple necrotizing granulomata positive for the presence of Histoplasmosis species. The patient recovered appropriately and was discharged on post-operative day five. CONCLUSIONS This case demonstrates a successful approach to a ruptured mycotic splenic artery pseudoaneurysm resulting in a positive outcome. It is a unique case as it highlights, to our knowledge, the first report of splenic artery aneurysm secondary to Histoplasma capsulatum infection. This report helps further the understanding of the pathophysiology as well as the natural history of mycotic splenic pseudoaneurysms.
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Affiliation(s)
- Mitchell H Mirande
- Department of Surgery, TriHealth, Good Samaritan Hospital, Cincinnati, OH, USA.
| | - Dante L S Souza
- Department of Surgery, TriHealth, Good Samaritan Hospital, Cincinnati, OH, USA
| | - Louis Thibodeaux
- Department of Surgery, TriHealth, Bethesda North Hospital, Cincinnati, OH, USA
| | - Cody Sutphin
- Department of Surgery, TriHealth, Good Samaritan Hospital, Cincinnati, OH, USA
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2
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Smith SA, Auld M, Ogg M, Chandrasegaram MD. Open splenic artery aneurysm repair in a patient with previous laparoscopic sleeve gastrectomy. BMJ Case Rep 2022; 15:e250082. [PMID: 36423939 PMCID: PMC9693678 DOI: 10.1136/bcr-2022-250082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We present the case of a female patient in her 40s who underwent a splenic artery aneurysm (SAA) repair following a previous laparoscopic sleeve gastrectomy (SG). We aim to discuss the management approach to SAAs and considerations in the setting of previous bariatric surgery.The patient consented to this case report. We include preoperative and postoperative radiological images and intraoperative images.While pseudoaneurysms following bariatric surgery have been reported, we present a case of a likely true SAA following SG. Our experience may assist others who come across similar cases in the future.
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Affiliation(s)
- Sonya Ann Smith
- General Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Michael Auld
- General Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Murray Ogg
- Vascular Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Manju Dashini Chandrasegaram
- General Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia
- Northside Clinical School, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Mousavimaleki A, Amr B, Taherzadeh M, Rokhgireh S, Setaredan SA, Kermansaravi M. Post-Bariatric Splenic Complications; Diagnosis and Treatment. A Systematic Review. Obes Surg 2022; 32:3125-3137. [PMID: 35778627 DOI: 10.1007/s11695-022-06190-x] [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: 05/21/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
Abstract
This systematic review intends to evaluate incidence and symptoms of post-bariatric splenic complications as well as best available modalities establishing the diagnosis and management protocols. A systematic literature search was performed in electronic database until March 2022. A total of 41 articles were included on the subject of splenic complications following bariatric/metabolic surgery (BMS). Splenic abscess was the most common splenic complications (44.2%) after BMS and leak was the most common reported etiology of the splenic abscess. Fever and abdominal pain were the most common presenting symptom in all splenic complications and CT scan was the most common diagnostic modality. Splenic complications after BMS are relatively rare but may lead to dangerous consequences. Prompt diagnosis and treatment can prevent potentially life-threatening outcomes.
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Affiliation(s)
- Ali Mousavimaleki
- Minimally Invasive Surgery Research Center, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Bassem Amr
- Taunton and Somerset Foundation Trust, Taunton, UK
| | - Mahsa Taherzadeh
- Minimally Invasive Surgery Research Center, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Rokhgireh
- Endometriosis Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Amin Setaredan
- Minimally Invasive Surgery Research Center, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, School of Medicine, Tehran, Iran. .,Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e Rasool Hospital, Tehran, Iran.
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Sasaki T, Ishibashi Y, Hatao F, Kawasaki K, Yamazaki R, Morita Y, Imamura K. A case of late postoperative intra-abdominal hemorrhage developing 13 months after laparoscopic sleeve gastrectomy. Asian J Endosc Surg 2022; 15:184-187. [PMID: 34089290 DOI: 10.1111/ases.12958] [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: 04/09/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
A 29-year-old male patient underwent laparoscopic sleeve gastrectomy (LSG) for morbid obesity and was discharged without any complications. Thirteen months later, he visited the emergency room with epigastric pain. A few hours before onset, he had had a larger-than-usual meal and vomited afterwards. Enhanced abdominal computed tomography revealed a hematoma 127 × 63 mm in diameter around the stomach. Angiography revealed no extravasation or pseudoaneurysm. Upper gastrointestinal endoscopy found no ulcers or abnormality of the stapler line scar from the LSG. The patient's vital signs were stable, and his hemoglobin had not fallen below the previous day's value. Conservative treatment was therefore chosen. The patient was discharged in stable condition after 11 days of hospitalization. However, the exact source of the hemorrhage was unable to be detected on the imaging findings. In view of his clinical course and the hematoma location, omental vessels were suspected of being the source of the hemorrhage.
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Affiliation(s)
- Takayoshi Sasaki
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | - Yuji Ishibashi
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | - Fumihiko Hatao
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | - Koichiro Kawasaki
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | - Ryoto Yamazaki
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | - Yasuhiro Morita
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | - Kazuhiro Imamura
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
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Thilakanathan C, Hall M, Rahman W, Magdy M, Jorgensen J. Unexplained recurrent left lower lobe pneumonia, haematemesis and splenomegaly in a 32-year-old gentleman. ANZ J Surg 2021; 92:258-259. [PMID: 34047426 DOI: 10.1111/ans.16976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/18/2021] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Cynthuja Thilakanathan
- Department of Gastroenterology and Hepatology, Sutherland Hospital, Sydney, New South Wales, Australia.,Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Hall
- Department of Gastroenterology and Hepatology, Sutherland Hospital, Sydney, New South Wales, Australia
| | - Wassim Rahman
- Department of Gastroenterology and Hepatology, Sutherland Hospital, Sydney, New South Wales, Australia.,Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Magdy
- Department of Surgery, St George Private Hospital, Sydney, New South Wales, Australia
| | - John Jorgensen
- Department of Surgery, St George Private Hospital, Sydney, New South Wales, Australia
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Najjari K, Talebpour M, Amirbeigi A. Ruptured Splenic Artery Pseudoaneurysm 3 Years After Laparoscopic Sleeve Gastrectomy. Obes Surg 2021; 31:4185-4187. [PMID: 34033011 DOI: 10.1007/s11695-021-05479-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/09/2021] [Accepted: 05/13/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Khosrow Najjari
- Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Talebpour
- Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Amirbeigi
- Department of General Surgery, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
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Pseudoaneurysm of the Splenic Artery Following Bariatric Surgery. Obes Surg 2021; 31:2295-2297. [PMID: 33405183 DOI: 10.1007/s11695-020-05146-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/24/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
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8
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Left gastric artery pseudo-aneurysm post sleeve gastrectomy: A case report. Int J Surg Case Rep 2020; 76:183-185. [PMID: 33038844 PMCID: PMC7550829 DOI: 10.1016/j.ijscr.2020.09.121] [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: 08/17/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 11/22/2022] Open
Abstract
Bleeding in the context of sleeve gastrectomy could be caused by a variety of diseases. Pseudo-aneurysm is an overlooked complication. Angiography followed by embolization is best for diagnosing and treating. Common risk factors for pseudo-aneurysm include, infection, trauma, neoplasm, inflammation and surgery. Treatment was surgical, this case was treated by interventional radiology.
Introduction Bleeding in the context of sleeve gastrectomy could be caused by a variety of diseases however pseudo-aneurysm is an overlooked complication. Case For instance, we present case of a 25 year-old Lebanese woman that undergone sleeve gastrectomy and presented 3 weeks later with a bleeding left gastric artery pseudo-aneurysm. Conclusion Angiography followed by embolization is best for diagnosing and treating the pseudo-aneurysm by coiling. Serious outcomes could arise from such a complication. Hence, accurate diagnosis and treatment using the appropriate methods is essential to avoid life-threatening events.
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Davrieux CF, Palermo M, Cúneo T, Zanutini D, Giménez ME. What is the Role of Image-Guided Endovascular Surgery in Postbariatric Surgery Bleeding Complications? J Laparoendosc Adv Surg Tech A 2020; 31:146-151. [PMID: 32936031 DOI: 10.1089/lap.2020.0696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Obesity treatment requires surgical procedures included in bariatric surgery. Bleeding complications are reported in 1%-4%. Image-guided surgery (IGS) includes minimally invasive procedures that have the advantage of less aggression to the patient, fewer complications, and a quick recovery. Endovascular therapy by interventional radiology (IR) is a minimally invasive image-guided procedure widely used in central, peripheral, and splanchnic vascular pathology. Treatment of postoperative bleeding in bariatric surgery can be aided by image-guided endovascular procedures. Objectives: The aim of this study is to carry out an update on the application of IR in bariatric surgery bleeding complications. Bleeding Complications: General rate of postoperative complications in bariatric surgery is 0%-10%. Postoperative bleeding (1%-4%) can be gastrointestinal (endoscopic treatment) or intra-abdominal (surgical treatment/relaparoscopy). In the case of arterial vascular lesions that cannot be resolved either endoscopically or surgically, the option of endovascular treatment with IR should be considered. Conclusions: Endovascular approach through IR and IGS in bleeding complications after bariatric surgery is presented as a valid minimally invasive therapy option in this group of patients.
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Affiliation(s)
- Carlos Federico Davrieux
- DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina.,Department of Surgery, Sanatorio de la Mujer, Rosario, Argentina
| | - Mariano Palermo
- DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina.,Department of Bariatric Surgery, Diagnomed, Buenos Aires, Argentina.,School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Tomás Cúneo
- Department of Interventional Radiology, Sanatorio Británico, Rosario, Argentina
| | - Daniel Zanutini
- Department of Interventional Radiology, Sanatorio Británico, Rosario, Argentina
| | - Mariano E Giménez
- DAICIM Foundation (Teaching, Research, Assistance in Minimal Invasive Surgery), Buenos Aires, Argentina.,School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.,IRCAD (Institute for Research on Cancer of the Digestive System), Strasbourg, France.,IHU-Strasbourg (Hospital-University Institute), Strasbourg, France
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Peters L, Zhao J, Makanyengo S, Pockney P. Delayed Splenic Artery Pseudoaneurysm After Laparoscopic Sleeve Gastrectomy. Obes Surg 2020; 31:872-874. [PMID: 32808170 DOI: 10.1007/s11695-020-04914-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/02/2020] [Accepted: 08/10/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Luke Peters
- Surgical Services, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, Australia. .,Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.
| | - Jie Zhao
- Surgical Services, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, Australia.,Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Samwel Makanyengo
- Surgical Services, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, Australia.,Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Peter Pockney
- Surgical Services, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, Australia.,Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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