Splenic artery aneurysm rupture: case report of this uncommon presentation

Endovascular and Open Surgical Treatment of Ruptured Splenic Artery Aneurysms: A Case Report and a Systematic Literature Review

BACKGROUND

Ruptured splenic artery aneurysms (r-SAA), although rare, are burdened by high morbidity and mortality, even despite emergent surgical repair. It is suggested that endovascular treatment can achieve reduction in peri-operative death and complication rates, as in other vascular diseases, but evidence of such benefits is still lacking in this particular setting. We report a case of an r-SAA treated by trans-arterial embolization and then converted to open surgery for persistent bleeding, and we provide a systematic review of current results of open and endovascular repair of r-SAAs.

MATERIALS AND METHODS

A 50-year-old male presenting in shock for a giant r-SAA underwent emergent coil embolization and recovered hemodynamic stability. On the following day, he underwent laparotomy for evacuation of the huge intraperitoneal hematoma, but residual bleeding was noted from the splenic artery, which was ligated after coil removal, and a splenectomy was performed. A systematic literature review of the reported mortality and complications of r-SAA undergoing open (OSR) or endovascular (EVT) treatment was performed using the main search databases. All primary examples of research published since 1990 were included regardless of sample size. The main outcome measures were mortality and reinterventions. Secondary outcomes were post-operative complications.

RESULTS

We selected 129 studies reporting on 350 patients-185 treated with OSR and 165 with EVT. Hemodynamically unstable patients and ruptures during pregnancy were more frequently treated with open repair. Overall, there were 37 deaths (mortality: 10.6%)-24 in the OSR group and 13 in the EVTr group (mortality: 12.9% and 7.8% respectively, p-value: 0.84). There were 37 reinterventions after failed or complicated endovascular repair -6 treated with endovascular re-embolization and 31 with laparotomy and splenectomy (22.4%); there were 3 (1.6%) reinterventions after open repair. Overall complication rates were 7.3% in the EVT group (n: 12) and 4.2% in the OSR group (n: 7), and did not require reintervention. No significant differences in overall complications or in any specific complication rate were observed between the two groups.

CONCLUSIONS

Current results of r-SAA treatment show equipoise terms of morbidity and mortality between open and endovascular repair; however, in case of hemodynamic instability and rupture during pregnancy, open surgery might still be safer. Moreover, endovascular repair is still burdened by a significantly higher rate of reinterventions, mostly with conversions to open surgery.

Syncope in a middle aged female: Splenic artery aneurysm revisited

Splenic artery aneurysm (SAA) is a rare potentially fatal condition with an estimated prevalence in the general population ranging between 0.2 and 10.4%. Ruptured splenic artery aneurysm poses a great diagnostic challenge to emergency physicians due to non-specific and potentially fatal presentations. Dual (arterial and venous) phase imaging is very important for identifying the source of an active intraabdominal bleed when patients are stable enough to tolerate the exam. Here, we present a case of a 54-year-old female who presented with syncope to the emergency department, diagnosed with ruptured splenic artery aneurysm.

Ruptured spontaneous splenic artery aneurysm: A case report and review of the literature

INTRODUCTION

Splenic artery aneurysm is a rare condition, however, potentially fatal. The importance of splenic artery aneurysm lies in the risk for rupture and life threatening hemorrhage.

PRESENTATION OF CASE

This is a case of a ruptured splenic artery aneurysm in a 58-year-old lady. She presented with hypovolemic shock and intra-peritoneal bleeding. Diagnosis was confirmed by CT angiography and she was managed by operative ligation of the aneurysm with splenectomy and distal pancreatectomy.

DISCUSSION

The literature pointed the presence of some risk factors correlating to the development of splenic artery aneurysm. In this article we discuss a rare case of spontaneous (idiopathic) splenic artery aneurysm and review the literature of this challenging surgical condition.

CONCLUSION

Splenic artery aneurysm needs prompt diagnosis and management to achieve a favorable outcome, high index of suspicion is needed to make the diagnosis in the absence of known risk factors.

Splenic artery aneurysm as an unusual cause of new onset ascites: a case report

Splenic artery aneurysm (SAA) is a rare and potentially life-threatening clinical entity that carries a risk of rupture and peritoneal hemorrhage. When ruptured, it typically manifests as abdominal pain with hemodynamic instability. This is a report about a 29-year-old male admitted for evaluation of recentonset ascites following the spontaneous resolution of a transient episode of severe epigastric and left upper quadrant pain with syncope the preceding day. Paracentesis revealed bloody fluid. Abdominal computed tomographic angiography (CTA) and magnetic resonance venography (MRV) showed a three centimeter SAA. During admission, prompt exploratory laparotomy was performed that revealed excessive intraperitoneal hemorrhage due to a ruptured SAA. The pathology report confirmed that the SAA had developed secondaryto atherosclerosis. Careful history taking together with appropriate imaging tests and emergent surgical intervention led to a timely diagnosis and the patient' ssurvival.

Abdominal pain and collapse in the emergency department

Rupture of a splenic artery aneurysm is a rare but life-threatening presentation to the emergency department. This case demonstrates the importance of swift resuscitation and the benefit of bedside imaging in a highly unstable patient. The definitive management of this condition in patients who are refractory to resuscitative attempts is immediate surgery with the diagnosis often only confirmed at laparotomy.