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Splenic Artery Aneurysm Presenting as Extrahepatic Portal Vein Obstruction: A Case Report
T. P. Elamurugan,S. Suresh Kumar,R. Muthukumarassamy,Vikram Kate
Case Reports in Gastrointestinal Medicine , 2011, DOI: 10.1155/2011/908529
Abstract: Splenic artery aneurysms are the most common visceral aneurysm occuring predominantly in females. They are usually asymptomatic, and the symptomatic presentation includes chronic abdominal pain of varied severity or an acute rupture with hypotension. Splenic artery aneurysm causing extrahepatic portal hypertension is very rare and is due to splenic vein thrombosis that develops secondary to compression by the aneurysm. We report one such rare presentation of splenic artery aneurysms in a pregnant female with the features of EHPVO (variceal bleed, hypersplenism) treated by splenectomy along with excision of the aneurysm.
Endovascular Treatment of Giant Splenic Artery Aneurysm  [PDF]
Adenauer Marinho de Oliveira Góes Junior,Amanda Silva de Oliveira Góes,Paloma Cals de Albuquerque,Renato Menezes Palácios,Simone de Campos Vieira Abib
Case Reports in Surgery , 2012, DOI: 10.1155/2012/964093
Abstract: Introduction. Visceral artery aneurysms are uncommon. Among them, splenic artery is the most common (46–60%). Most splenic artery aneurysms are asymptomatic and diagnosed incidentally, but its rupture, potentially fatal, occurs in up to 8% of cases. Presentation of Case. A female patient, 64 years old, diagnosed with a giant aneurysm of the splenic artery (approximately 6.5?cm in diameter) was successfully submitted to endovascular treatment by stent graft implantation. Discussion. Symptomatic aneurysms and those larger than 2?cm represent some of the main indications for intervention. The treatment may be by laparotomy, laparoscopy, or endovascular techniques. Among the various endovascular methods discussed in this paper, there is stent graft implantation, a method still few reported in the literature. Conclusion. Although some authors still consider the endovascular approach as an exception to the treatment of SAA, in major specialized centers these techniques have been consolidated as the preferred choice, reserving the surgical approach in cases where this cannot be used. For being a less aggressive approach, it offers an opportunity of treatment to patients considered “high risk” for surgical treatment by laparotomy/laparoscopy. 1. Introduction Visceral artery aneurysms (VAAs) are uncommon. Among them, splenic artery is the most common (46–60%), followed by hepatic artery (20%) and superior mesenteric artery (5-6%) [1–6]. Seventy-five percent of VAAs are asymptomatic. The most common symptom is pain in the upper left quadrant of the abdomen or in the epigastrium, radiating to left shoulder, nausea, and vomiting. [1, 2, 7, 8]. The rupture occurs in 3% to 8% of cases, is manifested by hypovolemic shock, and is potentially fatal [1, 2, 4, 7, 8]. The splenic artery aneurysms can be approached by laparotomy, laparoscopy, or endovascular techniques. The endovascular option, less invasive, has less morbidity and faster postoperative recovery [1–4, 8]. Among the various endovascular techniques, covered stent implantation has been little reported in the literature. The authors present a case of splenic artery aneurysm treated by this method. 2. Presentation of Case A female patient, 64 years old, controlled hypertension, and 2 previous pregnancies, presented as main complaint episodes of mild pain in the epigastrium and left hypochondrium, evolving for about 12 months. Physical examination of the abdomen was nonspecific, with ill-defined pain on palpation of the mesogastrium and left hypochondrium. In the hospital of origin she was submitted to
Surgical treatment of big splenic artery aneurysm: Case report
Ka?anski Milo?,Markovi? Vladimir,Pasternak Janko,Popovi? Vladan
Medicinski Pregled , 2009, DOI: 10.2298/mpns0908363k
Abstract: An aneurysm has been defined as a permanent local dilatation of the diameter of an artery by at least 50% of its normal value. A splenic artery aneurysm is most frequently a visceral artery aneurysm and clinically it is usually asymptomatic but potentially life-threatening at the same time, with the incidence of its rupturing being 2-10% and then the mortality rate ranges from 20 to 36%. A 51-year-old female patient was admitted to the Department of Vascular and Transplantation Surgery in Novi Sad having been found to have a big splenic artery aneurysm during the ultrasound examination of her abdomen after cholecystectomy. The additional diagnostic procedure - computerized tomography of the abdomen with i.v contrast subtraction angiography-confirmed the splenic artery aneurysm to have the diameter of 5 cm and therefore the elective surgical treatment was indicated after the preoperative preparation and risk assessment. The aneurysm was exposed through Chevron incision, and the detailed surgical exploration was done after the omental bursa had been opened. The aneurysmectomy and the reconstruction of the splenic artery by the termino-terminal anastomosis were performed after the weakening of the wall had been verified. The biopsies of the liver and the aneurysmal sac were done during the surgery. The pathohistological finding confirmed the atherosclerotic etiology of the aneurysm. Since the postoperative course was normal, the patient was discharged on the eighth postoperative day.
Ruptured true aneurysm of the splenic artery: an unusual cause of haemoperitoneum.  [cached]
Deshpande A,Kulkarni V,Rege S,Dalvi A
Journal of Postgraduate Medicine , 2000,
Abstract: True aneurysm of the splenic artery is rare. Two cases of ruptured true splenic artery aneurysms are presented. The first patient was a 62-year-old female who presented within 6 hours of the onset of symptoms. The other was a 27-year-old non-alcoholic male patient who was admitted in a state of shock after 2 days of observation in a peripheral hospital. Both patients had haemoperitoneum and were subjected to exploratory laparotomy. Aneurysmectomy was performed in both the patients in addition to left splenopancreatectomy in the first case and splenectomy in the second. However, due to the prolonged preoperative shock, the second patient succumbed on the third postoperative day.
Haemosuccus pancreaticus due to true splenic artery aneurysm: a rare cause of massive upper gastrointestinal bleeding
S Sadhu,S Sarkar,R Verma,SK Dubey
Journal of Surgical Case Reports , 2010,
Abstract: “Haemosuccus pancreaticus” is an unusual cause of severe upper gastrointestinal bleeding and results from rupture of splenic artery aneurysm into the pancreatic duct. More commonly, it is a pseudoaneurysm of the splenic artery which develops as sequelae of pancreatitis. However, true aneurysm of the splenic artery without pancreatitis has rarely been incriminated as the etiologic factor of this condition. Owing to the paucity of cases and limited knowledge about the disease, diagnosis as well as treatment become challenging. Here we describe a 60-year-old male presenting with severe recurrent upper gastrointestinal bleeding and abdominal pain, which, after considerable delay, was diagnosed to be due to splenic artery aneurysm. Following an unsuccessful endovascular embolisation, the patient was cured by distal pancreatectomy and ligation of aneurysm.
Aneurisma de la arteria esplénica Splenic artery aneurysm  [cached]
Julio Díaz Mesa,Janet Domínguez Cordovés,Gabriel González Sosa,Glenis Madrigal Batista
Revista Cubana de Cirugía , 2008,
Abstract: En la enfermedad vascular abdominal, los aneurismas viscerales representan una fracción menor. Sin embargo, es importante conocerlos por la posibilidad de ruptura y hemorragia y el consiguiente riesgo para la vida. Se presenta el caso de una paciente con aneurisma de la arteria esplénica y se revisa la literatura correspondiente, con el objetivo de comunicar las alternativas diagnósticas y la conducta que se debe seguir. In the vascular abdominal disease, visceral aneurysms represent a lower fraction. However, it is important to know them for the possibility of rupture and hemorrhage and the consequent risk for life. The case of a patient with a splenic artery aneurysm is reported, and the corresponding literature is review aimed at communicating the diagnostic alternatives and the conduct to be followed
Ruptured Aneurysm of the Splenic Artery: A Rare Cause of Abdominal Pain after Blunt Trauma
Jalalludin Khoshnevis,Saran Lotfollahzadeh,Mohammad Reza Sobhiyeh,Hossein Najd Sepas
Trauma Monthly , 2013,
Abstract: Introduction: Splenic artery aneurysms (SAAs) are rare (0.2-10.4%); however, they are the most common form of visceral artery aneurysms. Splenic artery aneurysms are important to identify, because up to 25% of the cases are complicated by rupture. Post- rupture mortality rate is 25% -70% based on the underlying cause. Herein we present a young patient with abdominal pain after blunt abdominal trauma due to rupture of an SAA.Case Presentation: A 27-year-old male, without a remarkable medical history, who suffered from abdominal pain for 2 days after falling was admitted to the emergency department with hypovolemic shock. Upon performing emergency laparotomy a ruptured splenic artery aneurysm was found.Conclusions: It is important to consider rupture of a splenic artery aneurysm in patients with abdominal pain and hypovolemic shock.
Aberrant right subclavian artery and calcified aneurysm of kommerell's diverticulum: an alternative approach
Jose Alvarez, Sierra JL Quiroga, Adrio B Nazar, Martinez JM Comendador, Garcia J Carro
Journal of Cardiothoracic Surgery , 2008, DOI: 10.1186/1749-8090-3-43
Abstract: Aberrant right subclavian artery (ARSA) with Kommerell's diverticulum, is a rare congenital anomaly of the aortic arch found at postmorten examination with a frequency of 0,5% [1].In this lesion the right subclavian artery arises as the fourth branch of the aorta distal to the origin of the left subclavian artery, then comes to the right arm posterior to the esophagous. This anomaly occurs as a result of abnormal regression of the fourth aortic arch and persistence of patency of the right eight dorsal aortic segment [2]. An aortic diverticulum is found at the site of origin of the atretic arch and this diverticulum is termed the Kommerell's diverticulum [3]. A patient with an ARSA and calcified aneurysm of Kommerell's diverticulum is described in whon a new surgical approach was taken.A 72 year-old man who had a 10 – year history of hypertension, noninsulin-dependent diabetes, coronary artery disease (right coronary stent) and dizziness was referred to our hospital for severe dysphagia.Chest X-ray films showed a mass in the upper mediastinum (Fig 1). Computed tomographic scans (Fig 2) revealed a calcified aneurysm (5 cm) of an aberrant right subclavian artery and an abdominal aortic aneurysm (4 cm). Aortography demonstrated that the right and left carotid arteries and the left subclavian artery arose from the aortic arch in that order. The ARSA arose from the aneurysm of the Kommerell's diverticulum in the descending aorta.Bilateral carotid artery disease with proximal atherosclerotic narrowing was present. Elective surgery was performed through a midline sternotomy using cardiopulmonary bypass (33°) (CPB) and cold antegrade blood cardioplegic cardiac arrest. CPB was established with cannulation to the right femoral artery, the right common and the left common carotid arteries and right atrium. The left heart was vented through the right superior pulmonary vein.The ascending aorta was clamped and the heart was arrested, selective cerebral perfusion was started and t
Massive upper gastrointestinal haemorrhage due to direct visceral erosion of splenic artery aneurysm.  [cached]
Shahani R,Bijlani R,Dalvi A,Shah H
Journal of Postgraduate Medicine , 1994,
Abstract: Six male patients (age group: 30-60 years) with aneurysm of the splenic artery presented with massive upper gastrointestinal tract hemorrhage. Five patients presented with hematemesis and one with melena. Chronic pancreatitis was noted in all the patients, four of whom were chronic alcoholics. Endoscopy was not useful in diagnosis. Bleeding through the Ampulla of Vater was seen in the patient with melena. Angiography was diagnostic in all. Pancreatic resection including the aneurysm(2), and bipolar ligation with underrunning of the aneurysm (3) were the operative procedures. Distal pancreatectomy with pancreatogastrostomy was carried out in the patient with hemosuccus pancreaticus. If endoscopy is inconclusive, angiography and early intervention is recommended to reduce the high mortality associated with conservative management.
A Patient with Splenic Artery Aneurysm Rupture and the Importance of Rapid Sonography in the ED  [PDF]
Masayuki Iyanaga,Susan Watts,Takeshi Kasai
Emergency Medicine International , 2010, DOI: 10.1155/2010/893606
Abstract: We report a case of a splenic artery aneurysm rupture presenting with shock which required timely embolization therapy. This case demonstrates how the rapid use of bedside ultrasound by emergency department (ED) physicians can help identify the cause of shock and, therefore, initiate appropriate treatment quickly even if the cause is rare, as in this case. 1. Introduction Emergency physicians often care for patients who are clinically in shock and it can be difficult to determine the cause of the symptoms. In some cases, bedside ultrasound performed by the physician can provide clues that will quickly lead to a definitive diagnosis and appropriate management which can save a life. 2. Case Report A 76-year-old Asian male was brought to the emergency department (ED) from a nearby hospital clinic. The man had had an episode of syncope and was found kneeling in a hallway near the hospital clinic where he had a follow-up appointment for a thyroid mass. Nurses and a doctor from the clinic responded to the scene, and they said the man reported left flank pain, dizziness, and one episode of vomiting just after falling. His vital signs measured by nurses at the scene included BP 80/40, PR 40, and SpO2 92% (on room air). They reported that his physical examination at that time showed anemic conjunctivae in both eyes but equal and reactive pupils, his chest was clear to auscultation bilaterally, and that heart sounds were unremarkable. Otherwise his physical exam was considered noncontributory. They gave him oxygen by nasal cannula (3?L/min) and 750?mL of normal saline intravenously (IV), but his hypotension did not improve. Consequently, the man was sent emergently to the ED about 30 minutes after the incident. His vital signs on arrival to the ED were BP 82/not palpable, PR 40, RR 18, T 36.3, and SpO2 84% (oxygen 10?L/min). His past medical history was not significant except for hypertension and a left thyroid mass. His past surgical history included left inguinal hernia repair. He took two antihypertensive medications, doxazosin 1mg QD and nifedipin 40?mg QD. He denied allergies to medications or foods. Significant laboratory studies included hemoglobin 11.9?gm/dL, hematocrit 37.4%, WBC 5,700/ L, and platelets 115,000/ L. Electrolytes, liver and renal function tests, and cardiac enzymes were all normal. Arterial blood gas (ABG) results were PaO2 157.1?mm Hg, PaCO2 42.6?mm Hg, and HCO3 25.3?mEq/L under oxygen 3?L/min. His CXR was within normal limits while his EKG showed sinus bradycardia without signs of cardiac ischemia. On physical exam, mild tenderness in
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