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Dinh Luan N, Duc NM, Hong Son N, Minh Hien T, Anh Huy L, Tan Tai N, Tran Kinh B, Minh Loi H. A rare case report of acute upper gastrointestinal hemorrhage due to splenic artery pseudoaneurysm. SAGE Open Med Case Rep 2021; 9:2050313X211061910. [PMID: 34900257 PMCID: PMC8664300 DOI: 10.1177/2050313x211061910] [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: 09/08/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022] Open
Abstract
Splenic artery aneurysm and splenic artery pseudoaneurysm are rare vascular pathologies. The splenic artery represents the third most common site for intra-abdominal aneurysms. In contrast with true splenic artery aneurysm, splenic artery pseudoaneurysm is typically symptomatic, presenting with a range of symptoms, from abdominal pain to hemodynamic instability due to rupture. However, gastrointestinal hemorrhage is an uncommon complication of splenic artery pseudoaneurysm. We report a case of acute upper gastrointestinal hemorrhage due to splenic artery pseudoaneurysm rupture. The patient was successfully treated by endovascular intervention.
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Affiliation(s)
- Nguyen Dinh Luan
- Department of Radiology, Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.,Department of Radiology, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Nguyen Hong Son
- Department of General Surgery, Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| | - Tran Minh Hien
- Department of Radiology, Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| | - Le Anh Huy
- Department of Radiology, Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Tan Tai
- Department of Radiology, Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| | - Bui Tran Kinh
- Department of Radiology, Gia Dinh Hospital, Ho Chi Minh City, Vietnam
| | - Hoang Minh Loi
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue, Vietnam
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Cretcher M, Panick CEP, Boscanin A, Farsad K. Splenic trauma: endovascular treatment approach. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1194. [PMID: 34430635 PMCID: PMC8350634 DOI: 10.21037/atm-20-4381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/21/2020] [Indexed: 12/16/2022]
Abstract
The spleen is a commonly injured organ in blunt abdominal trauma. Splenic preservation, however, is important for immune function and prevention of overwhelming infection from encapsulated organisms. Splenic artery embolization (SAE) for high-grade splenic injury has, therefore, increasingly become an important component of non-operative management (NOM). SAE decreases the blood pressure to the spleen to allow healing, but preserves splenic perfusion via robust collateral pathways. SAE can be performed proximally in the main splenic artery, more distally in specific injured branches, or a combination of both proximal and distal embolization. No definitive evidence from available data supports benefits of one strategy over the other. Particles, coils and vascular plugs are the major embolic agents used. Incorporation of SAE in the management of blunt splenic trauma has significantly improved success rates of NOM and spleen salvage. Failure rates generally increase with higher injury severity grades; however, current management results in overall spleen salvage rates of over 85%. Complication rates are low, and primarily consist of rebleeding, parenchymal infarction or abscess. Splenic immune function is felt to be preserved after embolization with no guidelines for prophylactic vaccination against encapsulated bacteria; however, a complete understanding of post-embolization immune changes remains an area in need of further investigation. This review describes the history of SAE from its inception to its current role and indications in the management of splenic trauma. The endovascular approach, technical details, and outcomes are described with relevant examples. SAE is has become an important part of a multidisciplinary strategy for management of complex trauma patients.
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Affiliation(s)
- Maxwell Cretcher
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
| | - Catherine E P Panick
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
| | - Alexander Boscanin
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
| | - Khashayar Farsad
- Department of Interventional Radiology, Dotter Interventional Institute, Oregon Health and Science University, Portland, OR, USA
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3
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El Aidaoui K, Bensaad A, Habi J, El Yamani K, El Kettani C. Hemorrhagic Shock Revealing Rupture of Splenic Artery Pseudoaneurysm Three Years After Post-Traumatic Pancreatitis. Cureus 2021; 13:e15678. [PMID: 34277269 PMCID: PMC8283245 DOI: 10.7759/cureus.15678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/05/2022] Open
Abstract
Splenic artery pseudoaneurysm (SAP) is an uncommon entity but extremely serious, given the high mortality rate if untreated. Only a limited literature reports association with post-traumatic pancreatitis. We report the case of a 30-year-old man, who was brought to the emergency department (ED) for acute confusion. His past medical history includes trauma of right hypochondriac and epigastric regions, three years ago. Three days before his admission to the hospital, he experienced abdominal pain with nausea and vomiting, without transit disorders or fever. When examined, the patient was disoriented, pale with profuse sweating, cold extremities, and a temperature of 36.3°C. Blood pressure was 75/51 mmHg, heart rate was 126 beats per minute, and oxygen saturation was 96% on room air. The abdominal exam detected generalized abdominal sensitivity. A CT angiography of the abdomen revealed hemoperitoneum of medium abundance, with extravasation of the contrast product from the splenic artery. The size of the spleen was normal with a lower polar hypodense area. In addition, a pancreas of normal size, steady outlinings, seat of bilobed cystic formation suggested a pancreatic pseudocyst. This led us to suspect a rupture of a pseudoaneurysm of the splenic artery. A laparotomy was performed and showed an estimated 2 L hemoperitoneum. Active bleeding was noted from an SAP in the mid-portion of the splenic artery, next to the pancreatic pseudocyst. Ligation of the splenic artery and splenectomy was carried out. The patient was discharged home on the 10th post-operative day. Our case highlights an uncommon cause of hemorrhagic shock, but critical to recognize. Indeed, ruptured SAP needs to be promptly detected and managed, to avoid fatal complications if left untreated.
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Affiliation(s)
- Karim El Aidaoui
- Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Ahmed Bensaad
- Surgical Gastroenterology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Jihane Habi
- Radiology, Cheikh Khalifa International University Hospital, Mohamed VI University of Health Sciences, Casablanca, MAR
| | - Khalid El Yamani
- Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Chafik El Kettani
- Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR
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Yousaf MN, Chaudhary FS, Ehsan A, Wolff MA, Sittambalam CD. Association of splenic artery pseudoaneurysm with recurrent pancreatitis. J Community Hosp Intern Med Perspect 2020; 10:290-293. [PMID: 32864055 PMCID: PMC7431920 DOI: 10.1080/20009666.2020.1771070] [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] [Indexed: 11/04/2022] Open
Abstract
A pseudoaneurysm of the splenic artery (SAP) is a rare entity which is associated with pancreatitis in 52% of cases. In the presence of pancreatitis, the enzymatic damage to the wall of splenic artery results in pseudoaneurysm formation. The clinical presentation is variable and ranges from asymptomatic to hemodynamic instability. The diagnosis of SAP is challenging in the presence of peripancreatic fluid collection or pseudocyst, where CT abdomen can miss small pseudoaneurysms. Angiography is a useful modality to establish a definitive diagnosis. We present a 49-year-old male with a history of recurrent pancreatitis due to alcoholism who presented with acute abdominal pain and was found to have acute pancreatitis. Abdominal CT scan showed a peripancreatic fluid collection and hyperdense lesion at the splenic hilum, which was diagnosed as SAP on angiography. A transcatheter embolization was performed with complete resolution of symptoms thereafter.
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Affiliation(s)
- Muhammad Nadeem Yousaf
- Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, MD, USA.,Department of Internal Medicine, MedStar Good Samaritan Hospital, Baltimore, MD, USA.,Department of Internal Medicine, Medstar Franklin Square Medical Center, Baltimore, MD, USA
| | - Fizah S Chaudhary
- Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, MD, USA.,Department of Internal Medicine, MedStar Good Samaritan Hospital, Baltimore, MD, USA.,Department of Internal Medicine, Medstar Franklin Square Medical Center, Baltimore, MD, USA
| | - Amrat Ehsan
- Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, MD, USA.,Department of Internal Medicine, MedStar Good Samaritan Hospital, Baltimore, MD, USA.,Department of Internal Medicine, Medstar Franklin Square Medical Center, Baltimore, MD, USA
| | - Marcos A Wolff
- Department of Infectious Diseases, Medstar Franklin Square Medical Center, Baltimore, MD, USA
| | - Charmian D Sittambalam
- Department of Internal Medicine, Medstar Franklin Square Medical Center, Baltimore, MD, USA.,Department of Internal Medicine, Georgetown University Medical Center, Washington, DC, USA
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Abstract
True splenic artery aneurysms (SAA) are a rare, but potentially fatal, pathology. They are the third most common type of abdominal aneurysm, after aneurysms of the aorta and of the iliac artery, and account for almost the all aneurysms of visceral arteries. True aneurysms account for 60% of SAA and affect four times as many women as men, generally related to increased incidental or symptomatic findings that coincide with use of ultrasonography in pregnancy. Among pregnant patients, mortality after rupture is 65-75%, with fetal mortality exceeding 90%. There are multiple etiologies and it is believed that hormonal influences and changes in portal flow during gestation play an important role in development of SAA. This review discusses their history, epidemiology, pathophysiology, and diagnosis and current treatment techniques.
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Mišović M, Golubović J, Sekulić I, Dragović S, Rančic N. POSSIBILITY OF RADIOLOGICAL DIAGNOSTICS OF SPLENIC ARTERY PSEUDOANEURYSM-A CASE REPORT AND REVIEW OF LITERATURE. ACTA MEDICA MEDIANAE 2019. [DOI: 10.5633/amm.2019.0325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Unusual Case of Life-Threatening Gastro Intestinal Bleed from a Splenic Artery Pseudoaneurysm: Case Report and Review of Literature. Case Rep Gastrointest Med 2019; 2019:8528906. [PMID: 30881708 PMCID: PMC6381554 DOI: 10.1155/2019/8528906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/17/2018] [Accepted: 12/02/2018] [Indexed: 11/17/2022] Open
Abstract
Large upper gastro intestinal (GI) bleeding can be life-threatening. Splenic artery pseudoaenurysm (SAP) is rare but can cause massive upper GI bleeding. We report a case of a 57-year-old woman who had massive upper GI bleeding from SAP eroding into distal duodenum. Literature review shows SAP can bleed into stomach or pancreatic pseudocyst or biliary tree and peritoneal cavity; however, there are no previous reported cases of SAP bleeding into distal duodenum. Splenic artery embolization (SAE) is the preferred treatment for a bleeding SAP. Splenic infarcts can result following a SAE.
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