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Ornaghi S, Crippa I, Di Nicola S, Giardini V, La Milia L, Locatelli L, Corso R, Roncaglia N, Vergani P. Splenic artery aneurysm in obstetric patients: a series of four cases with different clinical presentation and outcome. Int J Gynaecol Obstet 2022; 159:474-479. [PMID: 35122689 DOI: 10.1002/ijgo.14133] [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] [Received: 09/03/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe four consecutive cases of splenic artery aneurysm with different clinical patterns of presentation among obstetric patients. METHOD A series of four cases of splenic artery aneurysm diagnosed in pregnant or post-partum women at our University center between January 1998 and December 2020. Clinical and radiological data were retrospectively obtained by reviewing paper and electronic medical records after acquiring patient's consent. RESULTS One case was completely asymptomatic and incidentally identified at the beginning of pregnancy, thus allowing for multidisciplinary treatment. The other three cases were unknown: two manifested with maternal collapse due to aneurysm rupture in the third trimester of gestation, whereas one presented with acute abdominal pain during the post-partum period and was successfully managed before rupture occurred. CONCLUSION Although being extremely rare, SAA rupture in obstetric patients can be associated with dramatic consequences. Since early suspicion and prompt intervention are essential to avoid fatal outcomes, promotion of knowledge of all the potential clinical patterns of presentation of SAA rupture among obstetric patients is mandatory.
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Affiliation(s)
- Sara Ornaghi
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Isabella Crippa
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
| | - Sara Di Nicola
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Valentina Giardini
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
| | - Laura La Milia
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Luca Locatelli
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Rocco Corso
- Department of Radiology, San Gerardo Hospital, Monza, Italy
| | - Nadia Roncaglia
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
| | - Patrizia Vergani
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
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Shabunin AV, Bedin VV, Tavobilov MM, Karpov AA, Tsurkan VA, Alieva FF, Pilyus FG. [Selecting the most appropriate surgical treatment of true splenic artery aneurysm]. Khirurgiia (Mosk) 2022:21-27. [PMID: 36223146 DOI: 10.17116/hirurgia202210121] [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: 06/16/2023]
Abstract
OBJECTIVE To analyze the results of diagnosis and treatment of true splenic artery aneurysms. MATERIAL AND METHODS We analyzed the results of diagnosis and treatment of 27 patients with true splenic artery aneurysm. All ones underwent surgical treatment at the Botkin Municipal Clinical Hospital between 2017 and 2021. Splenic artery aneurysm >1 cm was an indication for surgical treatment. Surgical option depended on aneurysm location. Laparoscopic splenectomy and aneurysmectomy were performed in 4 cases (14.8%), 5 (18.5%) patients underwent endovascular intervention, laparoscopic clipping was performed in 18 (66.7%) cases. Methods of surgical treatment, general and specific postoperative complications according to the Clavien-Dindo and ISGPS classifications were analyzed. RESULTS Laparoscopic clipping was accompanied by fewer general and specific postoperative complications. Specific complications after laparoscopic splenectomy occurred in 2 patients (BL according to the ISGPS 2016 classification). There was one case of acute pancreatitis after endovascular interventions. In long-term postoperative period, aneurysm recanalization after endovascular intervention was observed in 1 case. CONCLUSION Surgical treatment of splenic artery aneurysms requires a differentiated approach based on topographic and anatomical assessment of aneurysm relative to the arterial vessel.
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Affiliation(s)
- A V Shabunin
- Botkin Municipal Clinical Hospital, Moscow, Russia
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - V V Bedin
- Botkin Municipal Clinical Hospital, Moscow, Russia
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - M M Tavobilov
- Botkin Municipal Clinical Hospital, Moscow, Russia
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - A A Karpov
- Botkin Municipal Clinical Hospital, Moscow, Russia
| | - V A Tsurkan
- Botkin Municipal Clinical Hospital, Moscow, Russia
| | - F F Alieva
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
| | - F G Pilyus
- Sechenov First Moscow State Medical University, Moscow, Russia
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Laparoscopic and Robotic Surgery for Splenic Artery Aneurysm: A Systematic Review. Ann Vasc Surg 2020; 68:527-535. [DOI: 10.1016/j.avsg.2020.05.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 01/27/2023]
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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: 6] [Impact Index Per Article: 1.5] [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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Laparoscopic Resection of a Splenic Artery Aneurism with Spleen Preservation. Case Rep Surg 2020; 2020:2873560. [PMID: 32082686 PMCID: PMC6995316 DOI: 10.1155/2020/2873560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/08/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction. Splenic artery aneurisms (SAA) are the third most common aneurysms, with reported incidences up to 10.4%. There is a higher prevalence in women, and most are incidental findings on imaging studies. Symptomatic or SAA larger than 20 mm and aneurysms in pregnant or in women of childbearing age are indications for surgery, because of the increased risk of rupture. Treatment options include endovascular, laparoscopic, and open surgical approaches. Presentation of Case. A 50-year-old female patient with nonspecific abdominal pain performed a computed tomography scan and angiography, which revealed a 24 × 20 × 19 mm SAA. After a multidisciplinary discussion, selective laparoscopic excision of the aneurysm was performed, with spleen preservation. Perioperative course was uneventful, and the patient remained asymptomatic. Discussion. A multidisciplinary discussion is of major importance in guaranteeing the optimal treatment for any given visceral aneurysm. Not all SAA are amenable to endovascular treatment, and laparoscopic surgery has mostly replaced open procedures. Laparoscopic ligation and resection of the SAA with splenic preservation offers permanent treatment, with a low morbidity and short hospital stay. Conclusion Selective laparoscopic aneurysm resection is a safe and effective approach, with good short- and long-term results, allowing permanent treatment of SAA while maintaining splenic function.
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Tlili A, Trigui A, Dkhil O, Feki W, Rejab H, Ameur HB, Boujelbene S, Mnif Z. [Splenic artery aneurysm rupture at the end of pregnancy: a case study]. Pan Afr Med J 2019; 34:63. [PMID: 31762927 PMCID: PMC6859032 DOI: 10.11604/pamj.2019.34.63.18598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/19/2019] [Indexed: 11/20/2022] Open
Abstract
Les hémorragies lors de la grossesse peuvent être d'origine non obstétricale, la grossesse étant un terrain favorisant pour certaines étiologies du fait des modifications physiologiques qu'elle induit. Ces hémorragies non obstétricales sont rares mais sont responsables d'une mortalité materno-fœtale importante. Le pronostic dépend de la rapidité du diagnostic et d'une prise en charge multidisciplinaire. La rupture per gravidique d'un anévrysme de l'artère splénique (AAS) est une affection rare mais de pronostic redoutable. Le tableau clinique typique associant douleur abdominale, hypotension et anémie est très trompeur pour l'obstétricien qui évoque plus volontiers un hématome rétro placentaire ou une rupture utérine. Nous rapportant le cas d'une patiente enceinte ayant nécessité une laparotomie en urgence devant la découverte à l'imagerie d'une rupture d'anévrysme de l'artère splénique.
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Affiliation(s)
- Ahmed Tlili
- Faculté de Médecine de Sfax, Service de Chirurgie Viscérale et Générale, Hôpital Habib Bourguiba, Sfax, Tunisie
| | - Aymen Trigui
- Faculté de Médecine de Sfax, Service de Chirurgie Viscérale et Générale, Hôpital Habib Bourguiba, Sfax, Tunisie
| | - Oussema Dkhil
- Faculté de Médecine de Sfax, Service d'Imagerie Médicale, Hôpital Hedi Chaker, Sfax, Tunisie
| | - Wiem Feki
- Faculté de Médecine de Sfax, Service d'Imagerie Médicale, Hôpital Hedi Chaker, Sfax, Tunisie
| | - Haithem Rejab
- Faculté de Médecine de Sfax, Service de Chirurgie Viscérale et Générale, Hôpital Habib Bourguiba, Sfax, Tunisie
| | - Hazem Ben Ameur
- Faculté de Médecine de Sfax, Service de Chirurgie Viscérale et Générale, Hôpital Habib Bourguiba, Sfax, Tunisie
| | - Salah Boujelbene
- Faculté de Médecine de Sfax, Service de Chirurgie Viscérale et Générale, Hôpital Habib Bourguiba, Sfax, Tunisie
| | - Zeineb Mnif
- Faculté de Médecine de Sfax, Service d'Imagerie Médicale, Hôpital Hedi Chaker, Sfax, Tunisie
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Scholtz V, Meyer F, Schulz HU, Albrecht R, Halloul Z. [Vascular surgical aspects in abdominal surgery : Results from a tertiary care center over a 10-year time period]. Chirurg 2018; 90:307-317. [PMID: 30255373 DOI: 10.1007/s00104-018-0726-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] [Indexed: 10/28/2022]
Abstract
AIM To investigate the perioperative management and outcome of patients undergoing abdominal surgery with additional vascular (comorbid) alterations for internal quality assurance of the clinical results. METHODS Over a defined study period all consecutive cases of the aforementioned profile were documented and retrospectively analyzed as part of an ongoing prospective monocentric observational study to reflect the daily surgical practice. RESULTS Over 10 years (from January 1999 to December 2008), a total of 113 cases were registered. Pancreas resection including vascular reconstruction showed the highest percentage (30.1%). Within the target patient groups, similar outcome data were found compared with international reports. An exception was in the case of mesenteric ischemia, where open surgery was more frequently used in comparison to the study situation (included together were patients treated by surgery and interventions). The majority of vascular alterations during the postoperative course and iatrogenic lesions occurred following pancreas resection. In the therapeutic profile there are two particularly important measures, namely open surgery on one hand and image-guided radiology as well as endoscopy on the other hand. The majority of patients with a rare visceral artery aneurysm (considerable potential for rupture or erosion) were more frequently treated with image-guided interventional radiology versus open surgery. This conforms to the current well-established sequential patient (individual), results, and, in particular, risk-adapted staged treatment approach. CONCLUSION Additional vascular surgical treatment of problematic situations during abdominal surgery or in emergency cases is not daily routine; however, it is a challenging field including a considerable potential for complications (morbidity) and definitely mortality. This requires an experienced surgeon with high expertise, if possible in a center for vascular medicine.
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Affiliation(s)
- V Scholtz
- Klinik für Allgemein‑, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg A. ö. R., Magdeburg, Deutschland
| | - F Meyer
- Klinik für Allgemein‑, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg A. ö. R., Magdeburg, Deutschland.
| | - H-U Schulz
- Klinik für Allgemein- & Viszeralchirurgie, AMEOS Klinikum, Haldensleben, Deutschland
| | - R Albrecht
- Klinik für Allgemein‑, Viszeral- und minimal-invasive Chirurgie mit Thoraxchirurgie, Helios Klinikum, Aue, Deutschland
| | - Z Halloul
- Klinik für Allgemein‑, Viszeral-, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg A. ö. R., Magdeburg, Deutschland
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Toyoda Y, Kyokane T, Kawai T, Watanabe K, Koide F, Ochiai Y, Asai Y, Igami T, Kuze S. Laparoscopic surgery for the treatment of a ruptured aneurysm of the right gastric artery: a case report. Asian J Endosc Surg 2017; 10:70-74. [PMID: 27596384 DOI: 10.1111/ases.12323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/20/2016] [Accepted: 07/24/2016] [Indexed: 12/23/2022]
Abstract
Laparoscopic surgery for the treatment of a ruptured visceral artery aneurysm is recognized as a challenging procedure. Here, we describe our experience with laparoscopic surgery to treat a ruptured aneurysm of the right gastric artery. A 72-year-old woman was diagnosed with intra-abdominal hemorrhage caused by a ruptured aneurysm of the right gastric artery. Transcatheter arterial embolization failed because the right gastric artery could not be cannulated. Therefore, we performed laparoscopic surgery. Using laparoscopy, we detected that the bleeding from the aneurysm had ceased; thus, the planned procedure was successful. The operative time and intraoperative blood loss were 100 min and 5 mL, respectively. The patient was discharged 7 days after surgery. Laparoscopic surgery after the failure of transcatheter arterial embolization is a suitable and safe procedure for ruptured visceral artery aneurysms, provided the circulatory dynamics are stable as a result of the temporary cessation of bleeding from the ruptured aneurysm.
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Affiliation(s)
- Yoshitaka Toyoda
- Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan
| | - Takanori Kyokane
- Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan
| | - Toru Kawai
- Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan
| | | | - Fumihiko Koide
- Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan
| | - Yosuke Ochiai
- Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan
| | - Yuichi Asai
- Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan
| | - Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shingo Kuze
- Department of Surgery, Chutoen General Medical Center, Kakegawa, Japan
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Abstract
INTRODUCTION Fibrin sealants (FS) have been approved for use in the United States since 1998. Since approval, they have been used in a wide variety of clinical settings and new products continue to be introduced. AREAS COVERED This review covers the literature supporting the USA FDA-approved indications for FS products produced by Baxter Corp. Literature review of PubMed, the Cochrane Library, FDA approval documents and product websites yielded information contained in this article. Mechanism of action, efficacy and safety of these products are covered. EXPERT OPINION FS are generally safe, popular and are used for a wide variety of off-label indications. Their use appears to be expanding rapidly. For many uses, including approved ones, large well-controlled trials are still needed. Additionally, cost-effectiveness data for these products would be a great benefit in guiding their future use.
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Affiliation(s)
- Samuel P Mandell
- Harborview Medical Center , 325 9th Avenue, Box 359796, Seattle, WA 98104-2499 , USA +1 206 744 3140 ; +1 206 744 2896 ;
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Miao YD, Ye B. Intragastric rupture of splenic artery aneurysms: Three case reports and literature review. Pak J Med Sci 2013. [PMID: 24353598 DOI: 10.12669/pjms.292.2992] [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] [Indexed: 12/13/2022] Open
Abstract
Rupture of splenic artery aneurysm remains an uncommon cause of hypovolemic shock although it is the third most common intra-abdominal aneurysms. It is difficult to diagnosis timely and entails a significant morbidity and mortality. We present three uncommon cases of bleeding from upper gastrointestinal tract as a result of rupture of splenic artery aneurysm to stomach in patients with liver cirrhosis or infectious endocarditis. We also reviewed the literature and these case reports highlighted that rapid resuscitation, diagnostic imaging, surgical consultation, and alternatively transarterial embolization were the priorities in the management. Early diagnosis and intervention for ruptured splenic artery aneurysm are crucial for patient's survival; therefore, it must be kept in mind as feasible etiology of life-threatening gastrointestinal bleeding, especially in patients with underlying liver cirrhosis or infective endocarditis.
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Affiliation(s)
- Yang-de Miao
- Yang-de MIAO, Department of Gastroenterology, Taizhou Municipal Hospital, Taizhou 318000, Zhejiang, China
| | - Bei Ye
- Bei YE, Department of Gastroenterology, Taizhou Municipal Hospital, Taizhou 318000, Zhejiang, China
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Abstract
INTRODUCTION Splenic artery aneurysm is more frequently diagnosed today with the advancement and liberal use of imaging modalities. A symptomatic aneurysm, an aneurysm of any diameter in a pregnant woman or a woman of childbearing age, and an aneurysm >2 cm are all strong indications for surgery because of a significantly increased risk for splenic artery rupture. CASE DESCRIPTION A 35-year-old, morbidly obese, African American woman presented with constant left flank pain for 4 weeks. Angiography confirmed a 2.5-cm splenic artery aneurysm near the splenic hilum. Because angioembolization was unlikely to succeed because of extensive collaterals and the aneurysm's proximity to the splenic hilum, laparoscopic excision of the aneurysm with splenectomy was performed. DISCUSSION We report the successful laparoscopic surgical treatment of a 2.5-cm splenic artery aneurysm. Any splenic artery aneurysm with a significantly increased risk of rupture requires a prompt intervention. Although percutaneous embolization of the splenic artery is the most frequently applied therapy today, surgical repair is preferred for all symptomatic aneurysms because of the greater likelihood of success.
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Affiliation(s)
- Youngjin Kim
- Department of General Surgery, Arrowhead Regional Medical Center, Fontana, CA 92335, USA.
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Iida A, Katayama K, Yamaguchi A. Laparoscopic resection for splenic artery aneurysm using the lateral approach: report of two cases. Asian J Endosc Surg 2013; 6:147-50. [PMID: 23602003 DOI: 10.1111/ases.12000] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 08/22/2012] [Accepted: 09/11/2012] [Indexed: 11/28/2022]
Abstract
We report two cases of successful laparoscopic surgery for splenic artery aneurysm. In case 1, a 59-year-old man who had hypertension was admitted to the hospital with complaints of slight back pain. CT scan showed a winding splenic artery and an aneurysm behind the pancreas body. In case 2, a 71-year-old woman with hypertension consulted us and was diagnosed with splenic artery aneurysm. Her aneurysm increased from 1.2 mm to 20 mm at the 1-year follow-up. In both cases, we performed laparoscopic splenectomy, using the left lateral approach, to resect the aneurysm. Splenectomy was performed after the spleen had changed color. The operating times were 210 and 259 min, respectively and the bleeding was 60 and 100 mL, respectively. The postoperative course was uneventful. By using the lateral approach from the left side, we were able to precisely resect the splenic artery aneurysm under a stable laparoscopic view.
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Affiliation(s)
- Atsushi Iida
- Department of Gastroenterological Surgery, University of Fukui, Fukui, Japan.
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Samamé J, Kaul A, Garza U, Echeverria A, Galvani C. Laparoscopic aneurysm resection and splenectomy for splenic artery aneurysm in the third trimester of pregnancy. Surg Endosc 2013; 27:2988-91. [DOI: 10.1007/s00464-013-2822-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 01/07/2013] [Indexed: 01/13/2023]
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de Varona Frolov S, Betancor Heredia PA, Volo Pérez G, Martel Almeida E, Hernández Navarro J. Aneurisma de arteria esplénica roto y poliquistosis renal autosómica dominante. Caso clínico. ANGIOLOGIA 2012. [DOI: 10.1016/j.angio.2012.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Spanos CP, Ktenidis K, Saratzis N, Lazaridis I, Kiskinis D. Laparoscopic ligation of splenic artery aneurysms: report of two cases and literature overview. Updates Surg 2012; 66:73-6. [PMID: 22991329 DOI: 10.1007/s13304-012-0180-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 09/06/2012] [Indexed: 01/17/2023]
Affiliation(s)
- Constantine P Spanos
- First Department of Surgery, Aristotelian University School of Medicine, Fitziou 15, N751, 55236, Panorama-Thessaloniki, Greece,
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Tiberio GAM, Bonardelli S, Gheza F, Arru L, Cervi E, Giulini SM. Prospective randomized comparison of open versus laparoscopic management of splenic artery aneurysms: a 10-year study. Surg Endosc 2012. [PMID: 22752279 DOI: 10.1007/s00464-012-2413-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 05/21/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND: The literature does not support the choice between open and laparoscopic management of splenic artery aneurysms (SAA). METHODS: We designed a prospective, randomized comparison between open and laparoscopic surgery for SAA. Primary end points were types of surgical procedures performed and clinical outcomes. Analysis was developed on an intention-to-treat basis. RESULTS: Fourteen patients were allocated to laparotomy (group A) and 15 to laparoscopy (group B). Groups displayed similar patient- and aneurysm-related characteristics. The conversion rate to open surgery was 13.3 %. The type of surgical procedure performed on the splenic artery was similar in the two groups: aneurysmectomy with splenic artery ligature or direct anastomosis was performed in 51 % and 21 % of patients in group A and in 60 % and 20 % in group B, respectively. The splenectomy rate was similar (14 % vs. 20 %). Postoperative splenic infarction was observed in one case in each group. Laparoscopy was associated with shorter procedures (p = 0.0003) and lower morbidity (25 % vs. 64 %, p = 0.045). Major morbidity requiring interventional procedures and blood transfusion was observed only in group A. Laparoscopy was associated with quicker resumption of oral diet (p < 0.001), earlier drain removal (p = 0.046), and shorter hospital stay (p < 0.01). During a mean follow-up of 50 months, two patients in group A required hospital readmission. In group B, two patients developed a late thrombosis of arterial anastomoses. CONCLUSIONS: Our study demonstrates that laparoscopy permits multiple technical options, does not increase the splenectomy rate, and reduces postoperative complications. It confirms the supposed clinical benefits of laparoscopy when ablative procedures are required but laparoscopic anastomoses show poor long-term results.
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Affiliation(s)
- Guido A M Tiberio
- General Surgery, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy,
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Patient-perspective quality of life after laparoscopic and open hernia repair: a controlled randomized trial. Surg Endosc 2012; 26:2465-70. [DOI: 10.1007/s00464-012-2212-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 01/31/2012] [Indexed: 10/28/2022]
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Peris Tomás N, Martínez García R, Domingo Del Pozo C, Martínez Mas E, Martínez Abad M. [Laparoscopic approach in the treatment of visceral aneurysms by selective arterial embolisation]. Cir Esp 2010; 88:333-5. [PMID: 20206345 DOI: 10.1016/j.ciresp.2009.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 12/28/2009] [Accepted: 12/29/2009] [Indexed: 11/26/2022]
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19
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Grover BT, Gundersen SB, Kothari SN. Video. Laparoscopic distal pancreatectomy and splenectomy for splenic artery aneurysm. Surg Endosc 2010; 24:2318-20. [PMID: 20177922 DOI: 10.1007/s00464-010-0942-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Accepted: 01/16/2010] [Indexed: 01/26/2023]
Abstract
BACKGROUND Large splenic artery aneurysms are rare but comprise 60% of all visceral artery aneurysms. Most are found incidentally and rupture in the nonpregnant patient has an approximate 25 to 36% mortality rate. Historically these have been managed with an open surgical approach for resection. METHODS We present the case of a 43-year-old man with a recent episode of bacterial endocarditis with an incidental finding of a large 6-cm splenic artery aneurysm. There was noted to be splenic vein occlusion and multiple splenic infarcts versus abscesses on preoperative imaging. There were concerns that this represented a mycotic aneurysm. He underwent laparoscopic en bloc splenic artery aneurysm resection with splenectomy and distal pancreatectomy with preoperative prophylactic balloon catheter placement. RESULTS His large splenic artery aneurysm was adjacent to the splenic hilum. Due to the splenic vein occlusion, there were large collateral vessels complicating the dissection. Additionally, the aneurysm had dense adhesions to the tail of the pancreas from a desmoplastic reaction. To safely remove the aneurysm, a distal pancreatectomy was included with resection of the spleen. The specimen was successfully removed intact using the laparoscopic approach. The patient had an uneventful recovery and was discharged home on postoperative day 2. Final pathology revealed no evidence of bacterial etiology. CONCLUSIONS Laparoscopic distal pancreatectomy with splenectomy is an appropriate minimally invasive option for the treatment of splenic artery aneurysms. This video demonstrates the technical challenges and management options for successfully completing a distal pancreatectomy and splenectomy in the face of a splenic artery aneurysm.
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Affiliation(s)
- Brandon T Grover
- Department of Medical Education, Gundersen Lutheran Medical Foundation, La Crosse, WI, USA
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Spontaneous ruptured splenic artery aneurysm: a case report. CASES JOURNAL 2009; 2:7150. [PMID: 20181191 PMCID: PMC2827072 DOI: 10.4076/1757-1626-2-7150] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Accepted: 08/22/2009] [Indexed: 11/15/2022]
Abstract
Splenic artery aneurysms are rare. We discuss a case of a 58-year-old gentleman presenting with collapse and shock secondary to spontaneous splenic artery aneurysm rupture. Patient underwent laparotomy and splenectomy then discharged home within a week of presentation.
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