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Zhang J, Ratner M, Harish KB, Speranza G, Hartwell CA, Rao A, Garg K, Maldonado T, Sadek M, Jacobowitz G, Rockman C. The natural history and long-term follow-up of splenic artery aneurysms. J Vasc Surg 2024; 79:801-807.e3. [PMID: 38081394 DOI: 10.1016/j.jvs.2023.11.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE Although splenic artery aneurysms (SAAs) are the most common visceral aneurysm, there is a paucity of literature on the behavior of these entities. The objective of this study was to review the natural history of patients with SAA. METHODS This single-institution, retrospective analysis studied patients with SAA diagnosed by computed tomography imaging between 2015 and 2019, identified by our institutional radiology database. Imaging, demographic, and clinical data were obtained via the electronic medical record. The growth rate was calculated for patients with radiologic follow-up. RESULTS The cohort consisted of 853 patients with 890 SAAs, of whom 692 were female (81.2%). There were 37 women (5.3%) of childbearing age (15-50 years). The mean age at diagnosis was 70.9 years (range: 28-100 years). Frequently observed medical comorbidities included hypertension (70.2%), hypercholesterolemia (54.7%), and prior smoking (32.2%). Imaging indications included abdominal pain (37.3%), unrelated follow-up (28.0%), and follow-up of a previously noted visceral artery aneurysm (8.6%). The mean diameter at diagnosis was 13.3 ± 6.3 mm. Anatomic locations included the splenic hilum (36.0%), distal splenic artery (30.3%), midsplenic artery (23.9%), and proximal splenic artery (9.7%). Radiographically, the majority were saccular aneurysms (72.4%) with calcifications (88.5%). One patient (38-year-old woman) was initially diagnosed at the time of rupture of a 25 mm aneurysm; this patient underwent immediate endovascular intervention with no complications. The mean clinical follow-up among 812 patients was 4.1 ± 4.0 years, and the mean radiological follow-up among 514 patients was 3.8 ± 6.8 years. Of the latter, 122 patients (23.7%) experienced growth. Aneurysm growth rates for initial sizes <10 mm (n = 123), 10 to 19 mm (n = 353), 20 to 29 mm (n = 34), and >30 mm (n = 4) were 0.166 mm/y, 0.172 mm/y, 0.383 mm/y, and 0.246 mm/y, respectively. Of the entire cohort, 27 patients (3.2%) eventually underwent intervention (81.5% endovascular), with the most common indications including size/growth criteria (70.4%) and symptom development (18.5%). On multivariate analysis, only prior tobacco use was significantly associated with aneurysm growth (P = .028). CONCLUSIONS The majority of SAAs in this cohort remained stable in size, with few patients requiring intervention over a mean follow-up of 4 years. Current guidelines recommending treatment of asymptomatic aneurysms >30 mm appear appropriate given their slow progression. Despite societal recommendations for intervention for all SAAs among women of childbearing age, only a minority underwent vascular surgical consultation and intervention in this series, indicating that these recommendations are likely not well known in the general medical community.
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Affiliation(s)
- Jason Zhang
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Molly Ratner
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Keerthi B Harish
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Giancarlo Speranza
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - C Austen Hartwell
- Department of Radiology, New York University Langone Medical Center, New York, NY
| | - Abhishek Rao
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Karan Garg
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Thomas Maldonado
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Mikel Sadek
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Glenn Jacobowitz
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY
| | - Caron Rockman
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY.
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Ueda A, Saito K, Murase H, Kato T, Imafuji H, Morimoto M, Ogawa R, Takahashi H, Matsuo Y, Takiguchi S. Robotic resection for splenic artery aneurysm associated with neurofibromatosis type 1: a case report. J Med Case Rep 2024; 18:104. [PMID: 38481300 PMCID: PMC10938794 DOI: 10.1186/s13256-024-04440-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Neurofibromatosis type 1 is an autosomal-dominant disease characterized by café-au-lait spots and neurofibromas, as well as various other symptoms in the bones, eyes, and nervous system. Due to its connection with vascular fragility, neurofibromatosis type 1 has been reported to be associated with vascular lesions, such as aneurysms. However, there have been few reports of abdominal visceral aneurysms associated with neurofibromatosis type 1. Furthermore, there have been no reports of robotic treatment of aneurysms associated with neurofibromatosis type 1. In this report, we describe the case of a patient with neurofibromatosis type 1 with a splenic artery aneurysm who was successfully treated with robotic surgery. CASE PRESENTATION This report describes a 41-year-old Asian woman with a history of neurofibromatosis type 1 who was referred to our hospital for evaluation of a 28 mm splenic artery aneurysm observed on abdominal ultrasound. The aneurysm was in the splenic hilum, and transcatheter arterial embolization was attempted; however, this was difficult due to the tortuosity of the splenic artery. Thus, we suggested minimally invasive robotic surgery for treatment and resection of the splenic artery aneurysm with preservation of the spleen. The postoperative course was uneventful, and the patient was discharged on the eighth day after surgery. At 1 year of follow-up, the patient was doing well, with no evidence of recurrence. CONCLUSION We encountered a rare case of splenic artery aneurysm in a patient with neurofibromatosis type 1 who was successfully treated with robotic surgery. There is no consensus on treatment modalities for neurofibromatosis-related aneurysms, and endovascular treatment is considered safe and effective; however, surgery remains an important treatment modality. Especially in patients with stable hemodynamic status, robotic surgery may be considered as definitive treatment. To our knowledge, this is the first successfully treated case of a splenic artery aneurysm in a patient with neurofibromatosis type 1.
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Affiliation(s)
- Akihiko Ueda
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 4678601, Japan
| | - Kenta Saito
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 4678601, Japan.
| | - Hiromichi Murase
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 4678601, Japan
| | - Tomokatsu Kato
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 4678601, Japan
| | - Hiroyuki Imafuji
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 4678601, Japan
| | - Mamoru Morimoto
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 4678601, Japan
| | - Ryo Ogawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 4678601, Japan
| | - Hiroki Takahashi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 4678601, Japan
| | - Yoichi Matsuo
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 4678601, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, Aichi, 4678601, Japan
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Salimi J, Nikraftar P, Rashidi F, Azimi M, Shokri A. Emergent method for management of splenic artery aneurysms rupture: A case report. Int J Surg Case Rep 2024; 116:109406. [PMID: 38432167 PMCID: PMC10943993 DOI: 10.1016/j.ijscr.2024.109406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Although endovascular therapy is becoming more used for the treatment of splenic artery aneurysms (SAAs) instead of open surgery, there is limited information available on the emergent hybrid approach, selectively. We present our experience of hybrid therapy using an emergent endovascular balloon for inflow control and open resection. CASE PRESENTATION A 34-year-old woman was brought to the emergency room after it was reported that she had a pseudoaneurysm in her splenic artery at a different medical facility. The patient was hemodynamically stable. Then we underwent a combination of endovascular and open procedures, using balloon proximal control and open aneurysm resection. She was discharged from hospital on the fifth postoperative day after the operation. CLINICAL DISCUSSION There is no agreement on how to treat SAA patients. Endovascular procedures such as endovascular intervention are also being used, minimizing the risks of surgery and shortening the patient's hospital stay, but complications remain. We propose to try SAA's emergency hybrid strategy operation with a good prognosis and fewer complications. CONCLUSION It seems that, compared to open surgery alone when endovascular procedures were impossible, elective hybrid procedures are more secure and efficient in stable patients and could make the operation easier without more dissection for proximal control of splenic artery.
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Affiliation(s)
- Javad Salimi
- Department of Vascular Surgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran.
| | - Parham Nikraftar
- Department of Vascular Surgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Fatemeh Rashidi
- Department of Vascular Surgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Azimi
- School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amir Shokri
- Department of General Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Kai K, Hamada T, Sakae T, Sato Y, Hiyoshi M, Inomata M, Suzuki Y, Nakamura S, Azuma M, Nanashima A. A case of multifocal sclerosis angiomatoid nodular transformations of the spleen occurring after partial splenic infarction with transcatheter arterial embolization for splenic artery aneurysm. Clin J Gastroenterol 2024; 17:198-203. [PMID: 37831375 DOI: 10.1007/s12328-023-01869-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/20/2023] [Indexed: 10/14/2023]
Abstract
A 48-year-old woman underwent transcatheter arterial embolization (TAE) for a splenic artery aneurysm, which resulted in a partial splenic infarction in the middle lobe. Five years after TAE, a 20-mm diameter mass in the noninfarcted area of the spleen was detected on imaging, which grew to 25 mm in diameter after 6 months. MRI after gadolinium administration showed a 35 × 34 mm mass within the superior pole and 15 × 12 mm mass within the inferior pole. The patient underwent laparoscopic splenectomy and had an uneventful postoperative recovery. No evidence of recurrence was observed during the 2-year follow-up period after surgery. The mass was pathologically confirmed to be sclerosing angiomatoid nodular transformation (SANT) of the spleen. While some studies hypothesize that SANT is a response to vascular injury or trauma, to the best of our knowledge, there have been no previous reports of SANT occurring after procedures directly affecting splenic blood flow. Additionally, multifocal SANTs are reported to be very rare, accounting for only 4.7% of all reported SANTs of the spleen. We highlight a rare course of SANT of the spleen and discuss the possible relationship between blood flow abnormalities and the appearance of SANT.
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Affiliation(s)
- Kengo Kai
- Department of Surgery, Faculty of Medicine, University of Miyazaki, 5200, Kihara, Kiyotake, Miyazaki, 889-1692, Japan
- Department of Anatomy, Histochemistry and Cell Biology, Faculty of Medicine, University of Miyazaki, 5200, Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Takeomi Hamada
- Department of Surgery, Faculty of Medicine, University of Miyazaki, 5200, Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
| | - Tatefumi Sakae
- Department of Radiology, Faculty of Medicine, University of Miyazaki, 5200, Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Yuichiro Sato
- Department of Diagnostic Pathology, Faculty of Medicine, University of Miyazaki, 5200, Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Masahide Hiyoshi
- Department of Surgery, Faculty of Medicine, University of Miyazaki, 5200, Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Mayu Inomata
- Department of Surgery, Faculty of Medicine, University of Miyazaki, 5200, Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Yasuto Suzuki
- Department of Surgery, Faculty of Medicine, University of Miyazaki, 5200, Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Sawa Nakamura
- Department of Radiology, Faculty of Medicine, University of Miyazaki, 5200, Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Minako Azuma
- Department of Radiology, Faculty of Medicine, University of Miyazaki, 5200, Kihara, Kiyotake, Miyazaki, 889-1692, Japan
| | - Atsushi Nanashima
- Department of Surgery, Faculty of Medicine, University of Miyazaki, 5200, Kihara, Kiyotake, Miyazaki, 889-1692, Japan
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Alexander E, Santos E. Endovascular management of incidentally discovered splenic arteriovenous fistula resulting from ruptured splenic aneurysm: Case report and review of the literature. Radiol Case Rep 2023; 18:2465-2469. [PMID: 37235078 PMCID: PMC10206381 DOI: 10.1016/j.radcr.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 05/28/2023] Open
Abstract
Splenic arteriovenous fistulas (SAVFs) are rare vascular anomalies, which have a described association with splenic artery aneurysms. Treatment options include surgical fistula excision, splenectomy, or percutaneous embolization. Here we present a unique case of endovascular repair of a splenic arteriovenous fistula (SAVFs) associated with a splenic aneurysm. A patient with past medical history of early-stage invasive lobular carcinoma was referred to our interventional radiology practice to discuss an incidentally discovered splenic "vascular malformation" discovered during magnetic resonance imaging of the abdomen and pelvis. Arteriography demonstrated smooth dilatation of the splenic artery, with a fusiform aneurysm which had fistulized to the splenic vein. There were high flows and early filling of the portal venous system. The splenic artery, immediately proximal to the aneurysm sac, was catheterized using a microsystem and embolized using coils and N-butyl cyanoacrylate. Complete occlusion of the aneurysm and resolution of the fistulous connection was achieved. The patient was discharged home the following day, without complication. Associated splenic artery aneurysms and SAVFs are rare occurrences. Timely management is necessary to prevent adverse sequelae such as aneurysm rupture, further enlargement of the aneurysmal sac, or portal hypertension. Endovascular treatment, including n-Butyl Cyanoacrylate glue and coils, offers a minimally invasive treatment option, with facile recovery and low morbidity.
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Fukamatsu F, Sugiura K, Takekoshi D, Fukuzawa T, Oyama K, Tsukahara Y, Kurozumi M, Shimizu A, Fujinaga Y. A ruptured splenic artery aneurysm treated by transcatheter arterial embolization using n-butyl cyanoacrylate-Lipiodol-Iopamidol. Radiol Case Rep 2023; 18:2385-2390. [PMID: 37179814 PMCID: PMC10172629 DOI: 10.1016/j.radcr.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/25/2023] [Accepted: 04/03/2023] [Indexed: 05/15/2023] Open
Abstract
N-butyl cyanoacrylate, one of embolic materials, is usually used as a mixture with Lipiodol (N-butyl cyanoacrylate-Lipiodol mixture). N-butyl cyanoacrylate-Lipiodol-Iopamidol was developed by adding a nonionic iodine contrast agent (Iopamiron) to N-butyl cyanoacrylate-Lipiodol mixture. N-butyl cyanoacrylate-Lipiodol-Iopamidol has lower adhesiveness than N-butyl cyanoacrylate-Lipiodol mixture and the ability to form a single large droplet. We report the case of a 63-year-old man with a ruptured splenic artery aneurysm treated by transcatheter arterial embolization using N-butyl cyanoacrylate-Lipiodol-Iopamidol. He was referred to the emergency room because of sudden onset of upper abdominal pain. A diagnosis was established using contrast-enhanced computed tomography and angiography. Emergency transcatheter arterial embolization was performed, and the ruptured splenic artery aneurysm was successfully embolized using a combination of coil framing and N-butyl cyanoacrylate-Lipiodol-Iopamidol packing. This case demonstrates the usefulness of a combination of coil framing and N-butyl cyanoacrylate-Lipiodol-Iopamdol packing for the embolization of aneurysms.
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Affiliation(s)
- Fumiaki Fukamatsu
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
- Corresponding author.
| | - Kazusa Sugiura
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Daiya Takekoshi
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Takuya Fukuzawa
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Kazuki Oyama
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Yoshinori Tsukahara
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Masahiro Kurozumi
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Akira Shimizu
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yasunari Fujinaga
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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Liu Z, Wang Y, Li J, Atogebania JW, Wei L, Bai F. Splenic artery aneurysm masked as a gastroenterology complication: A case report and literature review. Ann Med Surg (Lond) 2022; 82:104608. [PMID: 36268343 PMCID: PMC9577508 DOI: 10.1016/j.amsu.2022.104608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/03/2022] [Accepted: 09/04/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Splenic artery aneurysm has an insidious onset, and low incidence, most of which have no specific manifestations on the early onset and remains the most common visceral aneurysm and third most common splanchnic aneurysm as it still remains a challenge to deal with clinically by many clinicians. CASE PRESENTATION We report a single case of a young 21 years old girl who had no potential risk of splenic artery aneurysm on clinical presentation, for gastroenterology disease only assessment and attention in our facility. The patient born and raised on a tropical island in Southern China was clinically diagnosed with splenic artery aneurysm-associated gastroenterological complications which was presented earlier as hematemesis. The patient was considered to have received optimal critical care by our multidisciplinary team and classical features displayed within the clinical settings are worth documenting and contribute perfectly to medical literature as the patient on follow-up is now back to normal life. CLINICAL DISCUSSION Our patient recovered excellently on critically close follow-up since the patient had special gastroenterology associated complication features which masked the splenic artery aneurysm with very encouraging post-operative parameters or results. CONCLUSION The patient was considered to have received optimal multidisciplinary quaternary medical care for SAAs with gastroenterology-associated complications in our interventional cardiovascular and gastroenterology medicine department.
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Affiliation(s)
- ZhengJin Liu
- Department of Gastroenterology, Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Yong Wang
- Department of Interventional Radiology and Vascular Surgery, Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Jia Li
- Department of Urology, Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
- Corresponding author.
| | - Julius Wedam Atogebania
- Department of Surgery, Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - Ling Wei
- Department of Gastroenterology, Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
| | - FeiHu Bai
- Department of Gastroenterology, Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
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Sumitomo NF, Tamura M, Asano S, Yuasa E, Oyanagi T, Inoue M, Kodo K, Yamagishi H. Successful Preoperative Partial Splenic Artery and Aneurysm Embolization for Thrombocytopenia Associated with Failed Fontan Circulation. Int Heart J 2022; 63:984-988. [PMID: 36104230 DOI: 10.1536/ihj.22-083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Long-term complications after the Fontan procedure are important concerns for patients with pediatric and adult congenital heart disease. Although thrombocytopenia due to portal hypertension and hypersplenism is a well-known complication of the Fontan circulation, few studies have reported on its management. Herein we describe a young adult Fontan patient with thrombocytopenia and a splenic artery aneurysm caused by conduit stenosis. The patient required conduit replacement due to high venous pressure. We performed partial splenic artery embolization (PSE) and embolization of the aneurysm preoperatively to reduce the risk of bleeding, resulting in successful subsequent cardiac surgery. Preoperative evaluation of the splenic artery aneurysm was informative, and PSE was a safe and effective treatment option for thrombocytopenia to avoid bleeding during open-heart surgery in this patient.
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Affiliation(s)
| | - Masashi Tamura
- Department of Radiology, Keio University School of Medicine
| | - Satoshi Asano
- Department of Pediatrics, Keio University School of Medicine
| | - Erika Yuasa
- Department of Pediatrics, Keio University School of Medicine
| | | | - Masanori Inoue
- Department of Radiology, Keio University School of Medicine
| | - Kazuki Kodo
- Department of Pediatrics, Keio University School of Medicine
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Salimi J, Foroutani L, Miratashi Yazdi SA. Management of huge splenic artery aneurysm with new hybrid procedure including endovascular and open surgical approach: Case series. Int J Surg Case Rep 2021; 89:106585. [PMID: 34775324 PMCID: PMC8593227 DOI: 10.1016/j.ijscr.2021.106585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Splenic artery aneurysms (SAAs) account for more than half of all visceral artery aneurysms. Small SAAs are usually asymptomatic, but giant aneurysms are more likely to cause symptoms and result in life-threatening complications; these aneurysms treatment can be challenging. Splenic artery aneurysms treatment includes laparotomy, laparoscopy, or endovascular techniques. CASE PRESENTATION This case series reports the details of successful management of three patients with huge splenic artery aneurysms who underwent hybrid surgery, endovascular inflow control with a balloon, and open aneurysm resection. DISCUSSION Although endovascular treatment options are increasingly favored, only selected aneurysms are suitable for these procedures, as marked tortuosity of the artery or SAA in the proximal splenic artery may not be suitable for endovascular management. CONCLUSION Open surgery escorted by endovascular techniques can be considered an ideal treatment of SAA in the proximal region of the splenic artery.
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Affiliation(s)
- Javad Salimi
- Professor of Surgery, Vascular & Endovascular Surgeon, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Lale Foroutani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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10
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Wang A, Gao J. Spontaneous rupture of splenic artery aneurysm during pregnancy: A case report. Asian J Surg 2021; 45:739-741. [PMID: 34844830 DOI: 10.1016/j.asjsur.2021.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Aili Wang
- Department of Gynecology and Obstetrics, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China
| | - Jie Gao
- Department of Gynecology and Obstetrics, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China.
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Silvestri V, Pontecorvi E, Filotico M, Coppola A, Lauria F, Bracale U, Corcione F. Laparoscopic splenic artery aneurysmectomy with ICG guided partial splenectomy: alternative approach. MINIM INVASIV THER 2021; 31:810-814. [PMID: 34694196 DOI: 10.1080/13645706.2021.1994420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We herein report the case of a voluminous splenic artery aneurysm (SAA) diagnosed in a 48 year-old Caucasian male patient. After endovascular treatment failure, considering the volumetric aneurysm increase and recurrent symptoms, a laparoscopic splenic artery aneurysmectomy with partial splenectomy guided by indocyanine green fluorescence (ICG) was performed. This conservative strategy leads to save a spleen volume of about 10 cm3 to avoid postsplenectomy thrombocytosis and infections, potential immunodeficiency and overwhelming postsplenectomy infection syndrome (OPSS) and to preserve pancreatic vascularization preventing distal pancreas injuries.
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Affiliation(s)
- Vania Silvestri
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Naples, Italy
| | - Emanuele Pontecorvi
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Naples, Italy
| | - Marcello Filotico
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Naples, Italy
| | - Andrea Coppola
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Naples, Italy
| | - Federica Lauria
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Naples, Italy
| | - Umberto Bracale
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Naples, Italy
| | - Francesco Corcione
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Naples, Italy
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DeCarlo C, Mohebali J, Dua A, Conrad MF, Mohapatra A. Morbidity and mortality associated with open repair of visceral aneurysms. J Vasc Surg 2021; 75:632-640.e2. [PMID: 34560216 DOI: 10.1016/j.jvs.2021.08.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The Society for Vascular Surgery (SVS) recently published clinical practice guidelines on the management of visceral aneurysms. However, studies investigating the perioperative outcomes of open repair of visceral aneurysms have been limited to single-center experiences with variable results that span multiple decades. In the present study, we sought to detail the morbidity and mortality associated with open repair of visceral aneurysms using a national database in the contemporary era. METHODS National Surgical Quality Improvement Program data from 2013 to 2019 were queried for patients who had undergone open repair of visceral aneurysms, which had been classified as mesenteric, renal, or splenic using Current Procedural Terminology and International Classification of Diseases codes. The primary endpoint was the composite of major complications (cardiovascular, pulmonary, progressive renal failure, deep wound infection, return to operating room, sepsis) and 30-day mortality. Logistic regression was used to identify the predictors of the primary endpoint for nonruptured aneurysm cases. RESULTS Of the 304 aneurysms, 263 were nonruptured (137 mesenteric, 66 renal, 60 splenic) and 41 were ruptured (24 mesenteric, 1 renal, 16 splenic) and had undergone open repair. For those with nonruptured aneurysms, their mean age was 59.4 ± 14.7 years and 48.3% were women. For those with nonruptured aneurysms, the 30-day mortality was 1.9% and the major complication rate was 12.9%. A return to the operating room (5.3%) and prolonged ventilator support (3.8%) were especially common. As expected, rupture was associated with significantly greater mortality (22.0%; P < .001) and major complications (34.1%; P = .001). The use of postoperative transfusion was common in the elective group but was significantly greater in the ruptured group (24.3% vs 80.5%; P < .001). The predictors of the primary outcome for nonruptured aneurysms included male sex (odds ratio [OR], 2.93; 95% confidence interval [CI], 1.28-6.7; P = .011), anticoagulation (not discontinued before surgery) or bleeding disorder (OR, 4.52; 95% CI, 1.37-14.7; P = .012), and albumin <3.0 g/dL (OR, 4.66; 95% CI, 1.17-18.6; P = .029). Neither age nor aneurysm location were significant risk factors. CONCLUSIONS Open repair of visceral aneurysms was associated with acceptable morbidity and mortality, although these risks are significantly greater once ruptured. Male sex, bleeding risk, and low albumin were all risk factors for adverse events and should be considered for operative planning and postoperative care.
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Affiliation(s)
- Charles DeCarlo
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
| | - Jahan Mohebali
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Mark F Conrad
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Abhisekh Mohapatra
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
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Mesbahi M, Zouaghi A, Zaafouri H, Hadded D, Benzarti Y, Riahi W, Cherif M, Maamer AB. Surgical management of splenic artery aneurysm. Ann Med Surg (Lond) 2021; 69:102712. [PMID: 34429963 DOI: 10.1016/j.amsu.2021.102712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/08/2021] [Accepted: 08/08/2021] [Indexed: 02/08/2023] Open
Abstract
Introduction Splenic artery aneurysms are a rare arterial disease. They are considered as the most common visceral artery aneurysms and found mostly in multiparous women and patients with portal hypertension. Case presentation We present a case of an unruptured SAA of the hilum in a 58-year-old woman, with vague abdominal pain, treated by open splenectomy. Discussion Splenic artery aneurysms are often difficult to diagnose due to their vague or asymptomatic forms. However, they present a high risk of rupture that may cause fatal hemorrhage and death. Symptomatic artery aneurysms 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 in these patients’ groups. As known generally, the treatment of SAA has been surgical ligation of the splenic artery, ligation of the aneurysm or aneurysmectomy with or without splenectomy, depending on the aneurysm location. There are other percutaneous interventional procedures. Conclusion A multidisciplinary discussion is an important step in choosing the optimal treatment for visceral aneurysms. Surgical approaches should take place especially in cases where splenic perfusion is seriously threatened. Splenic artery aneurysms are a rare arterial disease, They are often difficult to diagnose due to their vague or asymptomatic forms. Their Management depends on their size, location, and presenting symptoms. Conventional surgery has not lost of its efficiency and indications, especially in hemodynamic emergencies, unexperienced surgeons or surgical history of laparotomy.
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Kakamad FH, Hammood ZD, Salih AM, Abdalla BY, Mohammed KS, Karim SO, Hamasalih HM, Salih RQ, Mohammed SH, Qadr OO, Sofi Mohammed HA, Hussein SI, Anwar SB, Abulkarim UY. Aneurysm of anomalous splenic artery arising from a splenomesenteric trunk: Review of the literature with a report of a new case. Int J Surg Case Rep 2021; 80:105618. [PMID: 33592420 PMCID: PMC7893412 DOI: 10.1016/j.ijscr.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Aneurysm of splenic artery arising from splenomesentric trunk is an extremely rare condition. The aim of this study is to report a new case with literature review. PRESENTATION OF CASE A 52-year-old housewife presented with mild central abdominal pain for two month duration. Abdomen was soft. Abdominal ultrasound examination showed a focal aneurysmal dilatation in the splenic artery (SA) near the portal vein. Abdominal computed tomographic angiography (CTA) revealed presence of the splenomesentric trunk with fusiform aneurysm (45 × 33 mm) of the proximal part of the SA. In supine position, through upper midline laparotomy incision, exploration of both superior mesenteric artery (SMA) and SA was performed, total excision of the aneurysm was done, the SMA was side-repaired and SA was ligated. The post-operative period was uneventful. DISCUSSION It is interesting to note that orthotopic SA aneurysms, most commonly present in the distal third of the artery, followed by the middle third, while in cases of splenomesentric trunk, all reported cases of anomalous SA aneurysms including the current one, showed the aneurysms to be located in the proximal portion or root of the SA. CONCLUSION Splenomesentric trunk is a rare anatomical anomaly, aneurysm of which is even rarer. It can be managed either by endovascular intervention or open surgery.
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Affiliation(s)
- Fahmi H Kakamad
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq; Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq.
| | - Zuhair D Hammood
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Abdulwahid M Salih
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq; Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
| | - Bzhwen Y Abdalla
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Shar Hospital, Sulaimani, Kurdistan, Iraq
| | - Karzan S Mohammed
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Shar Hospital, Sulaimani, Kurdistan, Iraq
| | - Sanaa O Karim
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; College of Nursing, University of Sulaimani, Sulaimani, Kurdistan, Iraq
| | - Hussein M Hamasalih
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; College of Nursing, University of Sulaimani, Sulaimani, Kurdistan, Iraq
| | - Rawezh Q Salih
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Shvan H Mohammed
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
| | - Othman O Qadr
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
| | | | | | - Sana B Anwar
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
| | - Usama Y Abulkarim
- Smart Health Tower, Madam Mitterrand Street, Sulaimani, Kurdistan, Iraq
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Shinde S. A Rare Quadruple Association: Fibromuscular Dysplasia, Giant Splenic Artery Aneurysm, Extrahepatic Portal Hypertension, and Hypersplenism. Indian J Crit Care Med 2021; 25:100-103. [PMID: 33603311 PMCID: PMC7874285 DOI: 10.5005/jp-journals-10071-23710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory vascular lesion. It is a very rare cause of splenic artery aneurysm (SAA). An 18-year-old girl presented with hematemesis, melena, pancytopenia, and splenomegaly. Endoscopy showed esophageal varices. Computed tomography angiography showed splenic infarct and a giant splenic artery aneurysm. Portal vein showed cavernous transformation with enlarged periportal and lienorenal collaterals. The liver and pancreas were unremarkable. Microscopy of the SAA revealed intimal fibroplasia and medial dysplasia. Symptoms of extrahepatic portal hypertension were relieved by aneurysmectomy, thus proving SAA as the underlying cause. Pancytopenia was reversed post-splenectomy, thus proving hypersplenism. This is the first-ever report showing a quadruple association of FMD, splenic artery aneurysm, extrahepatic portal hypertension, and hypersplenism.
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Chen JF, Danahey J, Fischer U, Nassiri N. Retreatment of a recanalized splenic artery aneurysm using a low-profile microembolization platform. J Vasc Surg Cases Innov Tech 2020; 6:553-6. [PMID: 33134641 DOI: 10.1016/j.jvscit.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/15/2020] [Indexed: 01/25/2023]
Abstract
Recanalization of a splenic artery aneurysm owing to incomplete transcatheter coil embolization is uncommon. In addition to the challenges of inherent vessel tortuosity, reintervention via catheterization of the main splenic artery presents unique difficulties in navigating across potentially obstructive preexisting coils. We describe here the application of a low-profile microembolization platform, most commonly used in neurovascular interventions, in the treatment of a tortuous, expanding splenic artery aneurysm that had previously undergone failed coil embolization.
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Fujii M, Yamashita S, Fudono A, Yanai S, Tashiro J, Takenaka Y, Yamasaki K, Ito E, Masaki Y. Splenic artery aneurysm rupture during pregnancy: A case report of maternal and fetal survival. Int J Surg Case Rep 2020; 76:94-7. [PMID: 33017742 DOI: 10.1016/j.ijscr.2020.09.173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Pregnancy has been demonstrated as a significant risk factor of splenic artery aneurysm (SAA) formation and rupture. However, prompt diagnosis of SAA rupture in a pregnant patient showing acute abdomen has been practically challenging in light of its rarity and vague initial presentation. PRESENTATION OF CASE A 40-year-old woman (gravida 1, para 0) at 35 weeks' gestation presented to the emergency department with upper abdominal pain and nausea. Because of fetal dysfunction, emergency caesarian section was performed by a Pfannenstiel incision. Following delivery, 400 g of hemorrhage was removed from the upper abdominal cavity. Computed tomography showed a 37-mm SAA associated with copious adjacent fluid. Although selective angiography did not demonstrate active extravasation, interventional isolation of the SAA was not performed because of multiple surrounding arteries. Relaparotomy with an upper midline incision was then performed. Sudden cardiac arrest occurred upon opening the lesser sac to irrigate clots, and cardiac massage and proximal and distal clamping of the SAA were required. Eventually, splenectomy with excision of the SAA and pancreatic tail was successfully performed, but gauze packing of the open surgical wound was required because of severe coagulopathy. Following removal of the packs and closure of the abdomen 2 days after splenectomy, the patient and infant satisfactorily recovered without sequelae. DISCUSSION Given continual awareness of abdominal vascular collapse during pregnancy, undelayed diagnosis and safer intervention might be achieved. CONCLUSION Awareness at initial presentation and multidisciplinary efforts might be essential to achieve maternal and fetal survival in SAA rupture during pregnancy.
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Panzera F, Inchingolo R, Rizzi M, Biscaglia A, Schievenin MG, Tallarico E, Pacifico G, Di Venere B. Giant splenic artery aneurysm presenting with massive upper gastrointestinal bleeding: A case report and review of literature. World J Gastroenterol 2020; 26:3110-3117. [PMID: 32587452 PMCID: PMC7304111 DOI: 10.3748/wjg.v26.i22.3110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/29/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Francesco Panzera
- Division of Gastroenterology, Department of Surgery, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Riccardo Inchingolo
- Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Marina Rizzi
- Division of Gastroenterology, Department of Surgery, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Assunta Biscaglia
- Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Matera 75100, Italy
| | | | - Emilia Tallarico
- Department of Pathology, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Giancarlo Pacifico
- Division of General Surgery, Department of Surgery, Madonna delle Grazie Hospital, Matera 75100, Italy
| | - Beatrice Di Venere
- Division of General Surgery, Department of Surgery, Madonna delle Grazie Hospital, Matera 75100, Italy
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Huff J, Valle O. Rupture of splenic artery aneurysm in pregnancy with double-rupture phenomenon: A case report. Case Rep Womens Health 2020; 27:e00230. [PMID: 32637324 PMCID: PMC7327824 DOI: 10.1016/j.crwh.2020.e00230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/23/2022] Open
Abstract
Background Rupture of a splenic artery aneurysm (SAA) is a rare and often life-threatening complication of pregnancy. The reported incidence is 0.01% to 10.4%. Maternal and fetal mortality have been reported to be as high as 75% and 95% respectively. Case Description A 26-year-old woman, gravida 5 para 3, presented at 32 weeks of gestation with diffuse abdominal pain and several episodes of syncope. An anchor diagnosis of abruption was made secondary to findings on presentation of intrauterine fetal demise and extensive history of substance abuse. Discussion This case is an example of anchoring bias despite good outcomes due to misleading prodromal and warning symptoms with initial favorable response to resuscitation. Conclusion A ruptured SSA should be considered in the differential of severe and unexplained pain in the left upper quadrant in pregnancy. A high degree of suspicion is required to make this diagnosis. The double rupture phenomenon can obscure a diagnosis of splenic artery aneurysm. Anchoring biases can delay correct diagnoses and treatment. Limited case reports of splenic artery aneurysms are reported in the literature and screening high risk patients could be beneficial. Care of patients with a ruptured splenic artery should be coordinated with a surgical specialty team such as vascular surgery, trauma surgery or general surgery when possible to improve outcomes.
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Affiliation(s)
- Jessie Huff
- Obstetrics & Gynecology, Geisinger Medical Center, 100 Academy Avenue, Danville, PA 17822, United States of America
| | - Orlando Valle
- Obstetrics & Gynecology, Geisinger Medical Center, 100 Academy Avenue, Danville, PA 17822, United States of America
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20
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Stoelting A, Esperti S, Balanchivadze N, Piacentino V, Mangano A. Sarcoidosis presenting as massive splenomegaly and severe epistaxis, case report. Ann Med Surg (Lond) 2020; 54:6-9. [PMID: 32322388 PMCID: PMC7160383 DOI: 10.1016/j.amsu.2020.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/11/2020] [Accepted: 03/23/2020] [Indexed: 12/17/2022] Open
Abstract
Sarcoidosis is a multisystem disorder of unknown etiology. Extrapulmonary sarcoidosis can involve any organ, but isolated spleen involvement is rare. Diagnosis can be challenging as other etiologies may have similar presentations. A 58-year-old African American female presented with life threatening epistaxis, anemia, refractory thrombocytopenia, and massive splenomegaly. Lymphoproliferative, infectious, and autoimmune etiologies were eliminated with laboratory testing and bone marrow biopsy. The patient had multiple splenic artery aneurysms precluding an open diagnostic splenectomy. Partial splenic artery embolization was performed, which normalized the platelet count and resolved the spontaneous bleeding. This allowed diagnostic splenectomy and splenic artery repair to be safely performed. Surgical pathology demonstrated extensive non-caseating granulomas consistent with sarcoidosis. We present this case to demonstrate the omnipotent nature of sarcoidosis and a complex multi-disciplinary approach for successful diagnosis and treatment. Sarcoidosis rarely presents with extrapulmonary involvement leading to life-threatening clinical scenarios. Splenic sarcoidosis as a source of life-threatening platelet sequestration. Splenectomy can be used as diagnostic and therapeutic intervention in sarcoidosis. Partial splenic artery embolization provides safe alternative to open splenic artery aneurysm repair.
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Affiliation(s)
- Austen Stoelting
- Department of Internal Medicine, Grand Strand Medical Center, 809 82nd Pkwy, Myrtle Beach, SC, 29572, USA
- Corresponding author.
| | - Shawn Esperti
- Department of Internal Medicine, Grand Strand Medical Center, 809 82nd Pkwy, Myrtle Beach, SC, 29572, USA
| | - Nino Balanchivadze
- Department of Internal Medicine, Grand Strand Medical Center, 809 82nd Pkwy, Myrtle Beach, SC, 29572, USA
| | - Valentino Piacentino
- Department of General Surgery, Grand Strand Medical Center, 809 82nd Pkwy, Myrtle Beach, SC, 29572, USA
| | - Andrew Mangano
- Department of Internal Medicine, Grand Strand Medical Center, 809 82nd Pkwy, Myrtle Beach, SC, 29572, USA
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Ceccarelli G, Gusai G, Rondelli F, Balestra F, De Rosa M. Video-robotic aneurysmectomy for splenic artery aneurysm: case report and literature review. MINIM INVASIV THER 2019; 29:244-249. [PMID: 31250696 DOI: 10.1080/13645706.2019.1623819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We herein report the case of a symptomatic splenic artery aneurysm (SAA) diagnosed in a 65-year-old woman. Endoluminal exclusion was considered as first option, but the potential risk of postoperative splenic infarction, postsplenectomy thrombocytosis and immunodeficiency in an otherwise healthy patient raised the possibility to carry out a surgical procedure of vascular reconstruction using the robotic device Da Vinci® Surgical System (Intuitive Surgical, Sunnyvale, CA, USA). We performed the resection of the aneurysm and the continuity of the splenic artery was restored by end-to-end anastomosis.
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Affiliation(s)
- Graziano Ceccarelli
- Department of General Surgery, San Giovanni Battista Hospital, Foligno, Italy
| | - Giampietro Gusai
- Department of General Surgery, San Francesco Hospital, Nuoro, Italy
| | - Fabio Rondelli
- Department of General Surgery, San Francesco Hospital, Nuoro, Italy
| | | | - Michele De Rosa
- Department of General Surgery, San Giovanni Battista Hospital, Foligno, Italy
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Affiliation(s)
- Adam Morton
- Department of Obstetric Medicine, Mater Health, Australia.
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Wiener Y, Tomashev R, Neeman O, Itzhakov Z, Heldenberg E, Melcer Y, Maymon R. Splenic artery aneurysms during pregnancy: An obstetric nightmare. Eur J Obstet Gynecol Reprod Biol 2019; 237:121-125. [PMID: 31035119 DOI: 10.1016/j.ejogrb.2019.04.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 03/11/2019] [Accepted: 04/18/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE In this study we report our experience in the management of Splenic Artery Aneurysm (SAA), diagnosed during pregnancy. STUDY DESIGN The current manuscript describes three different events, treated in out our department, involving SAAs diagnosed during pregnancy. Each case presents an unusual course and a unique clinical challenge. RESULTS The first case is of a 25 week's gestation twin pregnancy with ruptured SAA ending in maternal and fetal death. Another case of SAA rupture presented at 27 week's gestation with consequent emergency cesarean section and splenectomy. In the last case, two SAAs were incidentally diagnosed at 25 weeks' singleton gestation. The patient was managed conservatively and delivered by an elective cesarean section at 34 weeks followed by postpartum angiographic embolization of the aneurysms. CONCLUSIONS Health care providers and especially obstetricians should be aware of the diagnosis of ruptured SAA in a pregnant woman with abdominal discomfort and hemodynamic deterioration. In addition, once an asymptomatic pregnant patient is diagnosed with a SAA, conservative surveillance may be allowed.
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Affiliation(s)
- Yifat Wiener
- Departments of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Zerifin, 70300, Israel.
| | - Roni Tomashev
- Departments of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Zerifin, 70300, Israel
| | - Ortal Neeman
- Departments of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Zerifin, 70300, Israel
| | - Zalman Itzhakov
- Department of Interventional Radiology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Zerifin, 70300, Israel
| | - Eitan Heldenberg
- Department of Vascular Surgery, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Zerifin, 70300, Israel
| | - Yaakov Melcer
- Departments of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Zerifin, 70300, Israel
| | - Ron Maymon
- Departments of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Zerifin, 70300, Israel
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Miyasaka M, Ebihara Y, Yamamura Y, Tanaka K, Nakanishi Y, Asano T, Noji T, Kurashima Y, Nakamura T, Murakami S, Tsuchikawa T, Okamura K, Shichinohe T, Hirano S. Simultaneous surgical treatment for esophagogastric junctional cancer and splenic artery aneurysm resection with spleen preservation using fluorescence imaging: a case report. Surg Case Rep 2019; 5:44. [PMID: 30911865 PMCID: PMC6434000 DOI: 10.1186/s40792-019-0602-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background Recently, minimally invasive esophagectomy and gastrectomy for esophagogastric junctional (EGJ) cancer using either thoracoscopy or laparoscopy are frequently performed. In the past decade, minimally invasive surgery with laparoscopy for splenic artery aneurysm (SAA) has also been reported. However, patients with both EGJ cancer and SAA are rare. Case presentation A 66-year-old man, who complained of upper abdominal pain, was found to have esophagogastric junctional (EGJ) tumor. He was diagnosed as having Siewert type II adenocarcinoma. In a computed tomography (CT) scan before surgery, a 10-mm aneurysm in the splenic artery was found. Thus, we performed laparo- and thoracoscopic proximal gastrectomy and lower esophagectomy for EGJ cancer and splenic artery aneurysm (SAA) resection with spleen preservation using fluorescence imaging. We confirmed sufficient blood supply to the spleen after surgery with a postoperative CT scan. The blood supply to the spleen was suspected to be from the great pancreatic artery via the pancreas and from the omental branches of the left gastroepiploic artery via the omental artery. Conclusion Simultaneous surgery for EGJ cancer and SAA is rare due to its potential risk, but evaluation of the blood supply for the spleen by using fluorescence imaging can be useful for this procedure.
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Affiliation(s)
- Mamoru Miyasaka
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Yuma Ebihara
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Yoshiyuki Yamamura
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Kimitaka Tanaka
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Yoshitsugu Nakanishi
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Toshimichi Asano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Takehiro Noji
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Yo Kurashima
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Toru Nakamura
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Soichi Murakami
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Takahiro Tsuchikawa
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Keisuke Okamura
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Toshiaki Shichinohe
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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Wojtaszek M, Lamparski K, Wnuk E, Ostrowski T, Maciąg R, Rix T, Maj E, Milczarek K, Korzeniowski K, Rowiński O. Selective occlusion of splenic artery aneurysms with the coil packing technique: the impact of packing density on aneurysm reperfusion correlated between contrast-enhanced MR angiography and digital subtraction angiography. Radiol Med 2019; 124:450-459. [PMID: 30712163 DOI: 10.1007/s11547-019-00993-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 01/23/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim was to evaluate the relationship between coil packing densities after splenic artery aneurysm (SAA) treatment using detachable microcoils and rates of SAA reperfusion and to suggest a post-treatment surveillance protocol using contrast-enhanced MRA. MATERIALS AND METHODS Evaluated were 16 patients (4 men; mean age 46.7), who underwent true SAA embolization using detachable microcoils (Concerto, Medtronic). SAAs were treated by selective coil packing (CP) or stent-assisted coil exclusion (SAC). Contrast-enhanced magnetic resonance angiography (CE-MRA) and digital subtraction angiography (DSA) were performed at 3 months post-procedure and correlated. RESULTS Primary CP was used in 13 patients, while SAC was used in three patients. On follow-up, complete aneurysm occlusion was seen in seven patients (43.8%). Sac reperfusion occurred in nine patients (56.2%) and was demonstrated in all CE-MRA and six DSA studies. Mean aneurysm packing density was 20.10 ± 8.05% for the CP group and 32.90 ± 11.95% for the SAC group (p = 0.038). There was a significant difference in the incidence of aneurysm sac reperfusion on CE-MRA study between CP and SAC (9 vs. 0). No sac reperfusion was seen in aneurysms with packing densities ≥ 29%, irrespective of either embolization method. CONCLUSION Favorable midterm results for coil packing of SAAs seem to depend on the coil packing density with a coil volume approximately a quarter of the aneurysm volume being most effective. Follow-up should involve the use of CE-MRA as this modality has been shown to be superior over DSA in detecting aneurysm reperfusion and coil compaction. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Mikołaj Wojtaszek
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland. .,Vascular Unit, Kent & Canterbury Hospital, East Kent Hospital University NHS Trust, Canterbury, Kent, CT1 3NG, UK.
| | - Krzysztof Lamparski
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| | - Emilia Wnuk
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| | - Tomasz Ostrowski
- Department of General and Endocrine Surgery, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| | - Rafał Maciąg
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| | - Thomas Rix
- Vascular Unit, Kent & Canterbury Hospital, East Kent Hospital University NHS Trust, Canterbury, Kent, CT1 3NG, UK
| | - Edyta Maj
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| | - Krzysztof Milczarek
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| | - Krzysztof Korzeniowski
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
| | - Olgierd Rowiński
- 2nd Department of Clinical Radiology, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
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Chen G, Yang J, Qian G, Jiang K, Lv Y, Shi N, Zhu T. Spontaneous rupture of a splenic artery aneurysm with splenic epithelioid hemangioendothelioma: a case report. J Int Med Res 2019; 47:1059-1063. [PMID: 30614335 PMCID: PMC6381479 DOI: 10.1177/0300060518819372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Spontaneous rupture of a splenic artery aneurysm with splenic epithelioid hemangioendothelioma is a rare condition. Splenic artery aneurysm can be complicated by rupture resulting in hypovolemic shock, which can be fatal if not treat properly. We report a case of a 50-year-old man who presented with sudden onset of left upper quadrant pain and shock. This patient underwent splenectomy with distal pancreatectomy. His pathological diagnosis showed splenic epithelioid hemangioendothelioma.
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Affiliation(s)
- Ganghong Chen
- 1 Department of General Surgery, The People's Hospital of Zhuji, Zhuji, China
| | - Jing Yang
- 2 Department of Gastroenterology, The First Hospital of HangZhou, Hangzhou Hospital Affiliated to Nanjing Medical University, Hangzhou, China
| | - Guangyu Qian
- 1 Department of General Surgery, The People's Hospital of Zhuji, Zhuji, China
| | - Kexiang Jiang
- 1 Department of General Surgery, The People's Hospital of Zhuji, Zhuji, China
| | - Yanting Lv
- 3 Department of Pathology, The People's Hospital of Zhuji, Zhuji, China
| | - NaiChang Shi
- 4 Department of Radiology, The People's Hospital of Zhuji, Zhuji, Zhejiang Province, China
| | - Tieming Zhu
- 1 Department of General Surgery, The People's Hospital of Zhuji, Zhuji, China
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27
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Bacalbasa N, Balescu I, Tanase A, Pautov M, Brezean I, Vilcu M, Brasoveanu V. Spleno-pancreatectomy En Bloc with Parcelar Gastrectomy for Splenic Artery Aneurysm - A Case Report and Literature Review. In Vivo 2018; 32:915-919. [PMID: 29936480 DOI: 10.21873/invivo.11329] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 02/07/2023]
Abstract
Splenic artery aneurysms are common arterial lesions which might remain asymptomatic for a long period of time. In certain cases, these lesions might encounter a significant growth and might become symptomatic. Once diagnosed, a therapeutic strategy should be taken in consideration in order to avoid the apparition of life-threatening complications such as aneurysmal rupture. This is a case report of a 45-year-old patient diagnosed with a splenic artery aneurysm who was successfully submitted to an aneurysmal resection en bloc with distal spleno-pancreatectomy and parcelar gastrectomy.
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Affiliation(s)
- Nicolae Bacalbasa
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Alina Tanase
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Mihai Pautov
- "Dan Setlacec" Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Iulian Brezean
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"I. Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - Mihaela Vilcu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"I. Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - Vladislav Brasoveanu
- "Dan Setlacec" Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
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BACALBASA NICOLAE, BALESCU IRINA, TANASE ALINA, PAUTOV MIHAI, BREZEAN IULIAN, VILCU MIHAELA, BRASOVEANU VLADISLAV. Spleno-pancreatectomy En Bloc with Parcelar Gastrectomy for Splenic Artery Aneurysm - A Case Report and Literature Review. In Vivo 2018. [PMID: 29936480 PMCID: PMC6117755 DOI: 10.21873/invivo.112329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Splenic artery aneurysms are common arterial lesions which might remain asymptomatic for a long period of time. In certain cases, these lesions might encounter a significant growth and might become symptomatic. Once diagnosed, a therapeutic strategy should be taken in consideration in order to avoid the apparition of life-threatening complications such as aneurysmal rupture. This is a case report of a 45-year-old patient diagnosed with a splenic artery aneurysm who was successfully submitted to an aneurysmal resection en bloc with distal spleno-pancreatectomy and parcelar gastrectomy.
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Affiliation(s)
- NICOLAE BACALBASA
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | | | - ALINA TANASE
- Department of Stem Cell Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - MIHAI PAUTOV
- “Dan Setlacec” Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - IULIAN BREZEAN
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,“I. Cantacuzino” Clinical Hospital, Bucharest, Romania
| | - MIHAELA VILCU
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,“I. Cantacuzino” Clinical Hospital, Bucharest, Romania
| | - VLADISLAV BRASOVEANU
- “Dan Setlacec” Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
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29
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Al Jalbout N, Moreland AJ. Syncope in a middle aged female: Splenic artery aneurysm revisited. Clin Imaging 2018; 52:8-10. [PMID: 29494993 DOI: 10.1016/j.clinimag.2018.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/07/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
Abstract
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.
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Affiliation(s)
- Nour Al Jalbout
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Anna Jean Moreland
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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30
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Khan A, Freeman A, Patapanian H. Endovascular Treatment of a Splenic Aneurysm Associated With Segmental Arterial Mediolysis. EJVES Short Rep 2017; 36:1-4. [PMID: 29296681 DOI: 10.1016/j.ejvssr.2017.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 06/11/2017] [Accepted: 06/15/2017] [Indexed: 11/21/2022] Open
Abstract
Introduction Segmental arterial mediolysis is a rare disorder characterised by disintegration of the medial layer of an arterial wall usually affecting the intra-abdominal splanchnic vessels. Report A case of 50 year old man who presented with sudden-onset left sided flank pain is reported. A computed tomography mesenteric angiogram showed haemorrhage and a stable left upper quadrant haematoma arising from 8 × 8 mm splenic artery aneurysm. Discussion The patient underwent a successful endovascular coiling procedure to exclude the aneurysm and for complete resolution of his symptoms. Segmental arterial mediolysis (SAM) is a rare cause of bleeding from a splenic artery aneurysm. Endovascular treatment with coiling and embolisation could be a safe and effective technique to prevent rupture and complications arising from splenic artery aneurysms associated with SAM. Close follow-up is required in patients diagnosed with SAM.
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31
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Uy PPD, Francisco DM, Trivedi A, O’Loughlin M, Wu GY. Vascular Diseases of the Spleen: A Review. J Clin Transl Hepatol 2017; 5:152-164. [PMID: 28660153 PMCID: PMC5472936 DOI: 10.14218/jcth.2016.00062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 02/15/2017] [Accepted: 02/23/2017] [Indexed: 12/12/2022] Open
Abstract
Vascular diseases of the spleen are relatively uncommon in the clinical practice. However, the reported incidence has been progressively increasing, probably due to advances in the imaging modalities used to detect them. This disease condition often presents with non-specific clinical manifestations, but can be associated with significant morbidity and mortality. This review article aims to provide updated clinical information on the different vascular diseases of the splenic vasculature-splenic vein thrombosis, splenic vein aneurysm, splenic artery aneurysm, splenic arteriovenous fistula, and spontaneous splenorenal shunt-in order to aid clinicians in early diagnosis and management.
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Affiliation(s)
- Pearl Princess D. Uy
- Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA
- Department of Gastroenterology & Hepatology, University of Connecticut Health Center, Farmington, CT, USA
- *Correspondence to: Pearl Princess D. Uy, Department of Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-1235, USA. Tel: +1-860-810-9608, Fax: +1-860-679-4613, E-mail:
| | | | - Anshu Trivedi
- Department of Pathology, Hartford Hospital, Hartford, CT, USA
| | | | - George Y. Wu
- Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA
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32
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De Silva WSL, Gamlaksha DS, Jayasekara DP, Rajamanthri SD. A splenic artery aneurysm presenting with multiple episodes of upper gastrointestinal bleeding: a case report. J Med Case Rep 2017; 11:123. [PMID: 28468689 PMCID: PMC5415772 DOI: 10.1186/s13256-017-1282-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/31/2017] [Indexed: 12/13/2022] Open
Abstract
Background Splenic artery aneurysm is rare and its diagnosis is challenging due to the nonspecific nature of the clinical presentation. We report a case of a splenic artery aneurysm in which the patient presented with chronic dyspepsia and multiple episodes of minor intragastric bleeding. Case presentation A 60-year-old, previously healthy Sri Lankan man presented with four episodes of hematemesis and severe dyspeptic symptoms over a period of 6 months. The results of two initial upper gastrointestinal endoscopies and an abdominal ultrasound scan were unremarkable. A third upper gastrointestinal endoscopy detected a pulsatile bulge at the posterior wall of the gastric antrum. A contrast-enhanced computed tomogram of his abdomen detected a splenic artery aneurysm measuring 3 × 3 × 2.5 cm. While awaiting routine surgery, he developed a torrential upper gastrointestinal bleeding and shock, leading to emergency laparotomy. Splenectomy and en bloc resection of the aneurysm with the posterior stomach wall were performed. Histology revealed evidence for a true aneurysm without overt, acute, or chronic inflammation of the surrounding gastric mucosa. He became completely asymptomatic 2 weeks after the surgery. Conclusions Splenic artery aneurysms can result in recurrent upper gastrointestinal bleeding. The possibility of impending catastrophic bleeding should be remembered when managing patients with splenic artery aneurysms after a minor bleeding. Negative endoscopy and ultrasonography should require contrast-enhanced computed tomography to look for the cause of recurrent upper gastrointestinal bleeding.
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Affiliation(s)
- W S L De Silva
- Post Graduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - D S Gamlaksha
- Post Graduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | - D P Jayasekara
- Vascular and Transplant Surgical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - S D Rajamanthri
- Vascular and Transplant Surgical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
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Khan A, Ayub M, Haider I, Humayun M, Shah Z, Ajmal F. Coexisting giant splenic artery and portal vein aneurysms leading to non-cirrhotic portal hypertension: a case report. J Med Case Rep 2016; 10:270. [PMID: 27686495 PMCID: PMC5043529 DOI: 10.1186/s13256-016-1059-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Splenic artery aneurysms are the commonest visceral and third most common abdominal artery aneurysms, having a strong association with both pregnancy and multiparity. Here we report possibly the first case of a giant splenic artery aneurysm in association with a smaller portal vein aneurysm, in a woman who had never conceived, leading to non-cirrhotic portal hypertension. CASE PRESENTATION A 40-year-old Pakistani Asian woman who had no evidence of liver cirrhosis presented in April 2016 for a diagnostic workup of ascites, massive splenomegaly, and pancytopenia. An abdominal ultrasound followed by computed tomography angiography showed a giant aneurysm in her splenic artery and another smaller one in her portal vein. She underwent splenectomy and excision of the splenic artery aneurysm. Surgical findings included a giant splenic artery aneurysm pressing on her portal vein and causing its aneurysmal dilatation. On her first review in July 2016, she was generally in good health, ascites had subsided, and her full blood count was normal. Her portal vein aneurysmal dilatation, which was presumed to be secondary to the pressure effect from the splenic artery aneurysm, had shrunken remarkably in size. CONCLUSION A giant splenic artery aneurysm can cause non-cirrhotic portal hypertension and should be treated with splenectomy and aneurysmectomy.
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Affiliation(s)
- Abidullah Khan
- Resident Internal Medicine, Khyber Teaching Hospital, 25000, Peshawar, Pakistan.
| | - Maimoona Ayub
- Resident Internal Medicine, Khyber Teaching Hospital, 25000, Peshawar, Pakistan
| | - Iqbal Haider
- Resident Internal Medicine, Khyber Teaching Hospital, 25000, Peshawar, Pakistan
| | - Mohammad Humayun
- Resident Internal Medicine, Khyber Teaching Hospital, 25000, Peshawar, Pakistan
| | - Zakir Shah
- Resident Internal Medicine, Khyber Teaching Hospital, 25000, Peshawar, Pakistan
| | - Fahad Ajmal
- Resident Internal Medicine, Khyber Teaching Hospital, 25000, Peshawar, Pakistan
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Tannoury J, Honein K, Abboud B. Splenic artery aneurysm presenting as a submucosal gastric lesion: A case report. World J Gastrointest Endosc 2016; 8:496-500. [PMID: 27499832 PMCID: PMC4959943 DOI: 10.4253/wjge.v8.i14.496] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/23/2016] [Accepted: 06/16/2016] [Indexed: 02/05/2023] Open
Abstract
We are reporting the rare case of splenic artery aneurysm of 4 cm of diameter presenting as a sub mucosal lesion on gastro-duodenal endoscopy. This aneurysm was treated by endovascular coil embolization and stent graft implantation. The procedure was uneventful. On day 1, the patient presented an acute severe epigastric pain and cardiovascular arrest. Abdominal computed tomography scan showed an active leak of the intravenous contrast dye in the peritoneum from the splenic aneurysm. We performed an emergent resection of the aneurysm, and peritoneal lavage. Postoperatively, hemorrhagic choc was refractory to large volumes replacement, and intravenous vaso-active drugs. On day 2, he presented massive hematochezia. We performed a total colectomy with splenectomy and cholecystectomy for ischemic colitis, with spleen and gallbladder infarction. Despite vaso-active drugs and aggressive treatment with Factor VIIa, the patient died after uncontrolled disseminated intravascular coagulation.
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Kaya M, Baran Ş, Güya C, Kaplan MA. Prevalence and predictive factors for development of splenic artery aneurysms in cirrhosis. Indian J Gastroenterol 2016; 35:201-6. [PMID: 27256433 DOI: 10.1007/s12664-016-0670-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/10/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Splenic artery aneurysm (SAA) rarely occurs in the general population. Its increased incidence has been reported in cirrhosis. The aim of this retrospective study was to identify prevalence and predictive factor development of SAA in patients with cirrhosis. METHODS All patients with cirrhosis who were treated in our clinics between 2010 and 2014 were included in the study. Demographic features and clinical and laboratory findings were reviewed. Four-phase computerized tomography (CT) was used for identifying SAA. Imaging was reviewed for the presence of SAA as well as hepatic artery, portal vein, splenic artery, splenic vein, liver parenchyma, and intraabdominal cavity were evaluated. RESULTS A total of 171 patients (age 55±13.9, 109 men) were included in the study. There was SAA in 27 (15.7 %) patients. Mean diameter of aneurysm was 11.66 (range, 6.06-27.1) mm. Aneurysm was located in the distal part of splenic artery in 20 (74 %) patients and solitary in 24 (88.8 %), and asymptomatic in all patients. Patients with SAA had larger portal vein and splenic vein compared to patients without SAA (15.3±3.9 vs. 13.1±2.9 mm, p=0.001; and 12.5±4.4 vs. 9.6±2.7 mm, p<0.001, respectively). We identified positive correlation between development of SAA and splenic vein diameter [hazard ratio (HR) =1.23; 95 % confidence interval (CI) 0.97-1.57; p = 0.009] and negative correlation between hepatic artery diameter and development of SAA HR = 0.46; 95 % CI 0.25-0.85; p = 0.002). CONCLUSION SAA occurred in a significant proportion of patients with cirrhosis, and enlargement of the splenic vein seemed to be a predictive factor for the development of SAA.
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Abstract
Acute upper digestive tract hemorrhage most often arises from gastric and esophageal vessels located in the mucosa or the submucosa. Rupture in the upper gastrointestinal tract is a classical but uncommon complication of arterial (mainly the abdominal aorta) aneurysms. Splenic artery aneurysm usually ruptures in the peritoneum, unless it is associated with a disease eroding the gastrointestinal wall. We present and describe the management of the rare occurrence of an intragastric rupture of a splenic aneurysm associated with a pancreatic cancer.
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Naganuma M, Matsui H, Koizumi J, Fushimi K, Yasunaga H. Short-term outcomes following elective transcatheter arterial embolization for splenic artery aneurysms: data from a nationwide administrative database. Acta Radiol Open 2015; 4:2047981615574354. [PMID: 26443101 PMCID: PMC4580119 DOI: 10.1177/2047981615574354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 02/01/2015] [Indexed: 12/14/2022] Open
Abstract
Background Splenic artery aneurysm (SAA) rupture is life-threatening. Although elective transcatheter arterial embolization (TAE) suggested low in-hospital death in previous studies, there has been no large multi-center study of elective TAE for SAA. Purpose To examine the short-term outcomes of TAE for splenic artery aneurysm (SAA) and analyze the factors associated with the outcomes, including liver cirrhosis, using a nationwide administrative inpatient database. Material and Methods We identified patients who received elective TAE with a principal diagnosis of SAA. We assessed the patient background characteristics, comprising age, sex, and specific co-morbidities, including liver cirrhosis. The outcomes included the rate of TAE-related complications (acute pancreatitis, splenic infarction, splenic abscess, or intraperitoneal hematoma), length of stay, and in-hospital mortality. Results Among 18.3 million inpatients in the database between July 2010 and March 2013, we identified 534 patients who received elective TAE for SAA at 229 participating hospitals. Fifty-four (10.1%) patients had liver cirrhosis. No in-hospital deaths were observed. Thirty-two (6.0%) patients had at least one TAE-related complication. A multivariate linear regression analysis revealed that liver cirrhosis was significantly associated with longer length of stay (9.5 days; 95% confidence interval [CI], 7.0–12.0 days; P < 0.001). A logistic regression analysis showed that liver cirrhosis was not significantly associated with TAE-related complications (odds ratio, 0.99; 95% CI, 0.29–3.39; P = 0.980). Conclusion The results revealed no in-hospital mortality and a low complication rate associated with elective TAE for SAA including liver cirrhosis patients.
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Affiliation(s)
- Michio Naganuma
- Department of Radiology, Shonan Izumi Hospital, Kanagawa, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Jun Koizumi
- Department of Diagnostic Radiology, School of Medicine, Tokai University, Kanagawa, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Matsuda Y, Sakamoto K, Nishino E, Kataoka N, Yamaguchi T, Tomita M, Kazi A, Shinozaki M, Makimoto S. Pancreatectomy and splenectomy for a splenic aneurysm associated with segmental arterial mediolysis. World J Gastrointest Surg 2015; 7:78-81. [PMID: 26015853 PMCID: PMC4438451 DOI: 10.4240/wjgs.v7.i5.78] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 02/23/2015] [Accepted: 03/18/2015] [Indexed: 02/06/2023] Open
Abstract
Segmental arterial mediolysis (SAM) is characterized by intra-abdominal, retroperitoneal bleeding or bowel ischemia, and the etiology is unknown. A 44-year-old man complaining of abdominal pain was admitted to our hospital. He had been admitted for a left renal infarction three days earlier and had a past medical history of cerebral aneurysm with spontaneous remission. The ruptured site of the splenic arterial aneurysm was clear via a celiac angiography, and we treated it using trans-arterial embolization. Unfortunately, the aneurysm reruptured after two weeks, and we successfully treated it with distal pancreatomy and splenectomy. We recommended a close follow-up and prompt radiological or surgical intervention because SAM can enlarge rapidly and rupture.
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Colsa-Gutiérrez P, Kharazmi-Taghavi M, Sosa-Medina RD, Gutiérrez-Cabezas JM, Ingelmo-Setién A. [Splenic artery aneurysm. Report of a case]. CIR CIR 2015; 83:161-4. [PMID: 25986978 DOI: 10.1016/j.circir.2015.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 08/07/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The incidence of splenic artery aneurysm is not well known because they are often asymptomatic. CLINICAL CASE The case is presented of a 40 year-old woman diagnosed with a splenic artery aneurysm. She was clinically asymptomatic. A three-dimensional angiographic study was performed. The artery embolisation was rejected, according to the results of the study; thus it was decided to perform a laparoscopic splenic-aneurysmectomy. CONCLUSIONS Splenic artery aneurysms may present with non-specific symptoms, such as abdominal pain or anorexia. However 2-10% of aneurysms debut as spontaneous rupture. For this reason treatment is indicated in symptomatic aneurysms or those with rupture risk factors. In these cases there are different possibilities, such as therapeutic embolisation, endovascular stenting or surgery. Surgical approach varies depending on the location of the aneurysm in the splenic artery, enabling aneurysmectomy, splenic-aneurysmectomy, or aneurysm exclusion to be performed.
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Affiliation(s)
- Pablo Colsa-Gutiérrez
- Servicio de Cirugía General y Aparato Digestivo, Hospital Sierrallana, Torrelavega, Cantabria, España.
| | - Mahgol Kharazmi-Taghavi
- Servicio de Cirugía General y Aparato Digestivo, Hospital Sierrallana, Torrelavega, Cantabria, España
| | - Rocío Daniela Sosa-Medina
- Servicio de Cirugía General y Aparato Digestivo, Hospital Sierrallana, Torrelavega, Cantabria, España
| | | | - Alfredo Ingelmo-Setién
- Servicio de Cirugía General y Aparato Digestivo, Hospital Sierrallana, Torrelavega, Cantabria, España
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Papadomichelakis A, Anyfantakis D, Kastanakis M, Karona P, Bobolakis E. Rupture of a splenic artery aneurysm in a previously healthy 53-year-old male. J Med Life 2014; 7 Spec No. 2:69-70. [PMID: 25870677 PMCID: PMC4391356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Splenic artery aneurysms are unusual clinical conditions that may be ruptured resulting into adverse health outcomes. Pregnancy, portal hypertension and atherosclerosis are conditions that predispose to the formation of splenic artery aneurysms. A rare case of a previously healthy man referred to our department by his general practitioner complaining of acute abdominal pain is presented. During the hospital stay, the patient presented hemodynamic instability. Abdominal computed tomography disclosed perihepatic and perisplenic fluid accumulation. A diagnosis of ruptured splenic artery aneurysm was performed and the patient was operated successfully with splenectomy and ligation of the splenic artery. Although the condition is rare, physicians have to be aware of the high mortality rates caused by a ruptured splenic artery aneurysm and include this in the differential diagnosis when they encounter patients with acute abdominal pain and hemodynamic instability.
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Affiliation(s)
- A Papadomichelakis
- First Surgery Department, Saint George General Hospital, Chania, Crete, Greece
| | - D Anyfantakis
- Primary Health Care Centre of Kissamos, Chania, Crete, Greece
| | - M Kastanakis
- First Surgery Department, Saint George General Hospital, Chania, Crete, Greece
| | - P Karona
- First Surgery Department, Saint George General Hospital, Chania, Crete, Greece
| | - E Bobolakis
- First Surgery Department, Saint George General Hospital, Chania, Crete, Greece
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41
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Goshayeshi L, Vosoghinia H, Rajabzadeh F, Ahadi M, Asadi Sakhmaresi T, Farzanehfar MR. Splenic artery aneurysm as an unusual cause of new onset ascites: a case report. Middle East J Dig Dis 2014; 6:37-41. [PMID: 24829704 PMCID: PMC4005481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 12/28/2013] [Indexed: 11/06/2022] Open
Abstract
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.
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Affiliation(s)
- Ladan Goshayeshi
- Gastroenterology and Hepatology Department, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hassan Vosoghinia
- Gastroenterology and Hepatology Department, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farnood Rajabzadeh
- Radiology Department, Mashhad Branch, Islamic Azad University of Medical Sciences, Mashhad, Iran
| | - Mitra Ahadi
- Gastroenterology and Hepatology Department, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Tayyebeh Asadi Sakhmaresi
- Gastroenterology and Hepatology Department, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Farzanehfar
- Gastroenterology and Hepatology Department, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Lebreton-Chakour C, Boval C, Torrents J, Bartoli C, Leonetti G, Piercecchi-Marti MD. [Fatal hemorrhage in postpartum by rupture of a splenic artery aneurysm]. ACTA ACUST UNITED AC 2013; 41:617-9. [PMID: 24094666 DOI: 10.1016/j.gyobfe.2013.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 03/18/2013] [Indexed: 11/25/2022]
Abstract
The maternal mortality is rare and when it arises, the family often puts the medical profession in guilty's position. We present the case of a 38-year-old woman, died in the post-partum in a context of intense back pains. The autopsy found an incidental hemorrhagic syndrome to a two-stage rupture of the splenic artery. We shall discuss the aetiology. The autopsy and the anatomopathological examination are practiced only in hardly more than a quarter of the cases while they will be important in proceedings and will allow the family to go into mourning.
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Affiliation(s)
- C Lebreton-Chakour
- Service de médecine légale et droit de la santé, CHU Timone, Aix Marseille université, 13005 Marseille, France.
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43
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Benali M, Charrada H, Bouassida M, Bahloul A, Jmal K, Dhouib F, Saied MR, Khaddar MK. [ Splenic artery aneurysm rupture in late pregnancy: A case report]. ACTA ACUST UNITED AC 2013; 32:721-2. [PMID: 23993218 DOI: 10.1016/j.annfar.2013.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 06/28/2013] [Indexed: 11/15/2022]
Affiliation(s)
- M Benali
- Service d'anesthésie réanimation, hôpital Mohamed Tahr Maamouri, Nabeul, Tunisie.
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Löhr JM, Dinter D, Diehl SJ, Haas SL, Veeser M, Pfützer R, Retter J, Schönberg SO, Düber C, Keim V, Schadendorf D, Witt H. Rapid progression of a splenic aneurysm due to segmental arterial mediolysis: a rare cause of acute pancreatitis. Pancreatology 2013; 13:553-6. [PMID: 24075524 DOI: 10.1016/j.pan.2013.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 06/10/2013] [Accepted: 06/11/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND The etiology of acute pancreatitis can be manifold, beside the usual causes. We are reporting an unusual cause that triggered acute pancreatitis. PATIENT & RESULTS A 50 year-old male experienced attacks of acute pancreatitis (abdominal pain and elevated amylase and lipase) during sexual arousal. Serial imaging showed a rapidly-progressing, partly-thrombosed splenic artery aneurysm, with local compression of the pancreas. After angiographic coiling, the attacks subsided. Further angiography revealed additional aneurysms consistent with segmental arterial mediolysis at other sites of the body. Molecular analysis regarding Ehlers-Danlos-syndrome and genetic factors for pancreatitis, autoantibodies and Syphilis serology was negative. CONCLUSIONS Acute pancreatitis was triggered by a transient rise in blood pressure during sexual stimulation, which caused rapid progression of a splenic artery aneurysm as part of systemic segmental arterial mediolysis.
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Affiliation(s)
- J-Matthias Löhr
- Gastrocentrum, Karolinska Institute & University Hospital Huddinge, Stockholm, Sweden; Dept. of Medicine II, University Medical Center Mannheim, University of Heidelberg, Germany.
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Abstract
Splenic artery aneurysm (SAA) is a rare clinical entity that carries the risk of rupture and fatal hemorrhage. Ruptured SAA, especially during pregnancy has fateful consequences for the mother, foetus or both. The role of the Radiologist is very important in preventing mortality. A diagnosis of ruptured SAA should be considered in any pregnant patient who complains of sudden epigastric or upper abdominal pain, with or without shock. This is a report of two cases where the mothers were saved but the foetuses were lost.
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Affiliation(s)
- Manjula Dhinakar
- Department of Radiology, Sultan Qaboos Hospital, Salalah, Sultanate of Oman.
| | - Salem Al Mashini
- Deprament of Surgery, Sultan Qaboos Hospital, Salalah, Sultanate of Oman
| | - Viswanath Golash
- Deprament of Surgery, Sultan Qaboos Hospital, Salalah, Sultanate of Oman
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46
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Wakui N, Iida K, Kanayama M, Nagai H, Watanabe M, Ishii K, Kudo T, Kaneko H, Shibuya K, Sumino Y. Splenic artery aneurysm that gradually increased in size over 4 years until threatening rupture. J Med Ultrason (2001) 2011; 38:167-71. [PMID: 27278505 DOI: 10.1007/s10396-011-0303-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 02/22/2011] [Indexed: 12/01/2022]
Abstract
A 47-year-old man was referred to our hospital due to a splenic artery aneurysm. The course of the disease was monitored by ultrasound every 6 months. At each examination, the tumor was found to have increased in size by several millimeters, but the sonographer decided that the increase was within the range of error. After 4 years, the tumor showed a rapid increase in size. With a diagnosis of threatened rupture, the patient's life was saved by surgical intervention. In this case, the observations were only compared to the findings from the previous examination, and the slight increase in tumor size was considered within the range of error. It is important to compare the findings not only with those from the previous examination but also with earlier results.
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Affiliation(s)
- Noritaka Wakui
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Kazunari Iida
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Masahiro Kanayama
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Hidenari Nagai
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Manabu Watanabe
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Koji Ishii
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Takehide Kudo
- Division of Clinical Functional Physiology, Toho University Omori Medical Center, Tokyo, Japan
| | - Hironori Kaneko
- Division of Hepato-Biliary-Pancreatic Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Kazutoshi Shibuya
- Division of Surgical Pathology, Toho University Omori Medical Center, Tokyo, Japan
| | - Yasukiyo Sumino
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
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47
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Ohyama Y, Ishida H, Yoshida C, Konno J, Hoshino T, Watanabe H, Kudoh Y, Furukawa K, Watanabe T. Pseudoaneurysm in a chronic pancreatitis patient: report of a case, with emphasis on contrast-enhanced sonograms. J Med Ultrason (2001) 2010; 37:75-9. [PMID: 27277717 DOI: 10.1007/s10396-009-0239-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 08/06/2009] [Indexed: 10/20/2022]
Abstract
The association between pseudoaneurysm of the splenic artery and pancreatitis is now established. Rupture of an aneurysm is a lethal condition, and early diagnosis and treatment are required to prevent this hazardous life-threatening complication. In our case, early detection of pseudoaneurysm of the splenic artery enabled us to start prompt embolization, which yielded good results. Splenic infarction is known to be an important and frequent complication of transarterial embolization of splenic artery aneurysms. Thus, when performing transarterial embolization of a splenic artery aneurysm, this complication must be kept in mind and it is absolutely necessary to confirm the presence or absence of this complication after embolization of the aneurysm. In our case of pseudoaneurysm of the splenic artery due to acute aggravation of chronic pancreatitis, contrast-enhanced ultrasonography confirmed the spleen to be free from infarction. Thus, this technique is strongly recommended in such instances.
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Siablis D, Papathanassiou ZG, Karnabatidis D, Christeas N, Katsanos K, Vagianos C. Splenic arteriovenous fistula and sudden onset of portal hypertension as complications of a ruptured splenic artery aneurysm: Successful treatment with transcatheter arterial embolization. A case study and review of the literature. World J Gastroenterol 2006; 12:4264-6. [PMID: 16830391 PMCID: PMC4087390 DOI: 10.3748/wjg.v12.i26.4264] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Splenic arteriovenous fistula (SAVF) accounts for an unusual but well-documented treatable cause of portal hypertension[1-4]. A case of a 50-year-old multiparous female who developed suddenly portal hypertension due to SAVF formation is presented. The patient suffered from repeated episodes of haematemesis and melaena during the past twelve days and thus was emergently admitted to hospital for management. Clinical and laboratory investigations established the diagnosis of portal hypertension in the absence of liver parenchymal disease. Endoscopy revealed multiple esophageal bleeding varices. Abdominal computed tomography (CT) and transfemoral celiac arteriography documented the presence of a tortuous and aneurysmatic splenic artery and premature filling of an enlarged splenic vein, findings highly suggestive of an SAVF. The aforementioned vascular abnormality was successfully treated with percutaneous transcatheter embolization. Neither recurrence nor other complications were observed.
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Affiliation(s)
- Dimitrios Siablis
- Department of Radiology, Medical School, University of Patras, Rio 26504 Patras, Greece.
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