A hybrid repair of a superior mesenteric artery pseudoaneurysm using open mesenteric bypass and endovascular exclusion

Superior Mesenteric Artery Pseudoaneurysm Induced by Accidental Ingestion of a Foreign Body: Case Report

Background

Superior mesenteric artery (SMA) pseudoaneurysm is a very rare condition, typically associated with trauma, inflammation, and infection, and as a post-operative complication. If left untreated it can lead to serious consequences such as rupture and fatal haemorrhage.

Report

A 17 year old male presented to the emergency department with a history of intermittent progressive epigastric pain with no preceding significant symptoms of a possible cause. He was initially treated conservatively until the intensity of pain was so severe an abdominal computed tomography (CT) scan was justified. A pseudoaneurysm of the SMA was found. Full inflammatory and immunological workup was unremarkable. Repeat CT scan showed the SMA pseudoaneurysm was larger, mandating surgical intervention; the vascular surgeon suggested an exploratory laparotomy. Intra-operatively, unexpectedly, a wooden foreign body measuring 5.0 × 0.3 × 0.5 cm was seen once the aneurysm sac was opened. The pseudoaneurysm was repaired and the abdomen closed after ascertaining that all other organs were intact. The patient had a simple recovery with no complications and was discharged home. The follow up CT scans were unremarkable.

Conclusion

Pseudoaneurysm of the SMA in the paediatric age group is an extremely rare and life threatening phenomenon. The clinical presentation may be subtle, leading to delayed diagnosis. Early surgical intervention may be lifesaving and prevent further complications.

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Pseudoaneurysm due to swallowed foreign body is an extremely rare pathology.

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Visceral artery pseudoaneurysm are usually silent but potentially fatal.

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Surgical intervention is mainstay treatment of visceral artery pseudoaneurysm.

Congenital superior mesenteric artery aneurysm in a 6-week-old infant presenting with upper gastrointestinal bleeding

Visceral artery aneurysms are rare in infants and children. The majority of cases are caused by genetic syndromes, trauma, or infection. Although the majority of aneurysms are asymptomatic, visceral artery aneurysms can present with abdominal pain, nausea/vomiting, or rupture. Aneurysm rupture can manifest as hemodynamic instability and/or gastrointestinal bleeding. We present the case of a congenital idiopathic aneurysm of the superior mesenteric artery in a 6-week-old infant who presented with gastrointestinal bleeding. We report a stepwise surgical approach to achieving aneurysm exclusion and thrombosis, and highlight the robust mesenteric collateral circulation that can develop in pediatric patients.

Covered stent placement for emergency repair of a ruptured superior mesenteric artery pseudoaneurysm in advanced pancreatic head cancer

Superior mesenteric artery (SMA) pseudoaneurysms are rare but fatal. Surgical repair is an ideal treatment; however, it is inappropriate in patients with SMA pseudoaneurysm due to advanced cancer, and endovascular therapy is an alternative treatment for nonsurgical candidates. Here, we report a case of SMA pseudoaneurysm in a patient with advanced pancreatic cancer, which was successfully treated with the placement of a biliary covered stent.

Visceral artery pseudoaneurysms: two case reports and a review of the literature

BACKGROUND

Visceral artery pseudoaneurysms are relatively rare but have a high mortality rate in case of rupture. Their detection in the last decades is rising due to an increased use of computed tomography and angiography. However, due to the nonspecific nature of the clinical symptoms and signs, diagnosis is often delayed or missed. We describe two cases of patients presenting with nonspecific abdominal complaints and anemia leading to a diagnosis of visceral pseudoaneurysm. Both cases are successfully treated with a different endovascular intervention.

CASE PRESENTATION

The first case is a 67-year-old Caucasian man presenting with diffuse abdominal pain, vomiting, diarrhea, and weight loss. Digital angiography showed a complex pseudoaneurysm of the superior mesenteric artery. The patient was treated with stent placement and selective embolization of the afferent branches. The second patient is a 78-year-old Caucasian man with a history of chronic pancreatitis admitted with epigastric pain, rectal bleeding and melena. Angiography showed a pseudoaneurysm of the gastroduodenal artery. The patient was successfully treated with coil embolization.

CONCLUSIONS

We report two cases of visceral pseudoaneurysms and review the literature concerning etiology, presentation, diagnosis, and treatment. Visceral artery pseudoaneurysms should be considered in the differential diagnosis of a patient with nonspecific abdominal symptoms. Diagnosis is often made with computed tomography or computed tomography angiography but digital angiography remains the gold standard. Treatment options include surgical, endovascular or percutaneous interventions. The choice of treatment is case specific.