Ruptured splenic artery aneurysm

Giant splenic artery aneurysm presenting with massive upper gastrointestinal bleeding: A case report and review of literature

BACKGROUND

Splenic artery aneurysm (SAA) and pseudoaneurysm are rare vessel’s lesions. Pseudoaneurysm is often symptomatic and secondary to pancreatitis or trauma. True SAA is the most common aneurysm of visceral vessels. In contrast to pseudoaneurysm, SAA is usually asymptomatic until the rupture, with high mortality rate. The clinical onset of SSA’s rupture is a massive life-threatening bleeding with hemodynamic instability, usually into the free peritoneal space and more rarely into the gastrointestinal tract.

CASE SUMMARY

We describe the case of a 35-year-old male patient, with negative past medical history, who presented to the emergency department for massive upper gastrointestinal bleeding, severe anemia and hypotension. An esophagogastroduodenoscopy performed in emergency showed a gastric bulging in the greater curvature/posterior wall with a small erosion on its surface, with a visible vessel, but no active bleeding. Endoscopic injection therapy with cyanoacrylate glue was performed. Urgent contrast-enhanced computed tomography was carried out due to the clinical scenario and the unclear endoscopic aspect: The radiological examination showed a giant SAA which was adherent to posterior stomach wall, and some smaller aneurysms of the left gastric and ileocolic artery. Because of the high risk of a two-stage rupture of the giant SAA with dramatic outcome, the patient underwent immediate open surgery with aneurysmectomy, splenectomy and distal pancreatectomy with a good postoperative outcome.

CONCLUSION

The management of a ruptured giant SAA into the stomach can be successful with surgical approach.

Multiple Giant Splenic Artery Aneurysms with Hypersplenism and Portal Hypertension: A Case Report

Multiple giant splenic artery aneurysms (>10 cm in diameter) are rare. We report a patient presenting with these aneurysms who had also associated portal hypertension and massive splenomegaly. Almost all the aneurysms were sealed by endovascular means at the first stage. Later, for the residual aneurysms at splenic hilum and enlarged spleen, splenectomy was performed. She made an uneventful recovery.

Management of Giant Splenic Artery Aneurysm: Comprehensive Literature Review

To provide an overview of the medical literature on giant splenic artery aneurysm (SAA).The PubMed, Medline, Google Scholar, and Google databases were searched using keywords to identify articles related to SAA. Keywords used were splenic artery aneurysm, giant splenic artery aneuryms, huge splenic artery aneurysm, splenic artery aneurysm rupture, and visceral artery aneurysm. SAAs with a diameter ≥5 cm are considered as giant and included in this study. The language of the publication was not a limitation criterion, and publications dated before January 15, 2015 were considered.The literature review included 69 papers (62 fulltext, 6 abstract, 1 nonavailable) on giant SAA. A sum of 78 patients (50 males, 28 females) involved in the study with an age range of 27-87 years (mean ± SD: 55.8 ± 14.0 years). Age range for male was 30-87 (mean ± SD: 57.5 ± 12.0 years) and for female was 27-84 (mean ± SD: 52.7 ± 16.6 years). Most frequent predisposing factors were acute or chronic pancreatitis, atherosclerosis, hypertension, and cirrhosis. Aneurysm dimensions were obtained for 77 patients with a range of 50-300 mm (mean ± SD: 97.1 ± 46.0 mm). Aneurysm dimension range for females was 50-210 mm (mean ± SD: 97.5 ± 40.2 mm) and for males was 50-300 mm (mean ± SD: 96.9 ± 48.9 mm). Intraperitoneal/retroperitoneal rupture was present in 15, among which with a lesion dimension range of 50-180 mm (mean ± SD; 100 ± 49.3 mm) which was range of 50-300 mm (mean ± SD: 96.3 ± 45.2 mm) in cases without rupture. Mortality for rupture patients was 33.3%. Other frequent complications were gastrosplenic fistula (n = 3), colosplenic fistula (n = 1), pancreatic fistula (n = 1), splenic arteriovenous fistula (n = 3), and portosplenic fistula (n = 1). Eight of the patients died in early postoperative period while 67 survived. Survival status of the remaining 3 patients is unclear. Range of follow-up period for the surviving patients varies from 3 weeks to 42 months.Either rupture or fistulization into hollow organs risk increase in compliance with aneurysm diameter. Mortality is significantly high in rupture cases. Patients with an evident risk should undergo either surgical or interventional radiological treatment without delay.

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.

Giant splenic artery aneurysm: A rare but potentially catastrophic surgical challenge

INTRODUCTION

Splenic artery aneurysms are rare but clinically important entities because of their potential for life threatening rupture. They seldom exceed 3cms in size and only a few cases of giant splenic artery aneurysms (more than 10cm size) have been reported until now.

PRESENTATION OF CASE

A 58yr old female presented with painless pulsatile progressively enlarging lump in left upper abdomen. Contrast enhanced computed tomography revealed a 10.6×10.38cm aneurysm arising from distal splenic artery along with a normal pancreas. Surgical treatment in form of complete excision of the aneurysm along with spleen and distal pancreas was performed. Gross examination showed an unruptured 12.7×11.8cm true aneurysm of distal splenic artery. Postoperative course was uneventful.

DISCUSSION

Splenic artery aneurysms are discovered incidentally and the life time risk of rupture is 28% for giant aneurysms. Even with availability of less invasive procedures such as laproscopy or endovascular treatment, open surgery is mostly preferred.

CONCLUSION

Giant splenic artery aneurysms, although rare, should be considered in patients presenting with left upper abdomen pulsatile masses. Clinical suspicion followed by emergent management is necessary to prevent potentially life threatening complications.