Clinical Experiences of Splenic Artery Aneurysm

Abstract

Splenic artery aneurysms are the third most common intra-abdominal aneurysms. They are important vascular diseases because rupture of the splenic artery aneurysms is a clinical emergency and results in catastrophic hemorrhage and high mortality rate. The records of patients with documented splenic artery aneurysms diagnosed between 1985 and 1998 were reviewed. Seven were men and 2 women. Ages ranged from 31 to 85 years (mean 58.8 years). Three patients presenting with acute abdomen and shock were proved to have ruptured splenic artery aneurysms. Another 3 patients had nonspecific epigastric or left upper quadrant abdominal discomfort. Splenic artery aneurysms were impressed by a ring calcification on plain abdominal radiograph in 3 patients and by a cystic lesion on ultrasonogram in 5 patients. Further imaging studies including Doppler ultrasonography, contrast-enhanced abdominal computed tomography, magnetic resonance angiography, and celiac angiography may be required to confirm the diagnosis. The diameter of the aneurysms ranged from 0.6 to 13 cm (mean 4.2 cm). The size of the ruptured aneurysms ranged from 2 to 5 cm (mean 3.5 cm). All of the splenic artery aneurysms located at the distal third of the splenic artery. Three patients with ruptured splenic artery aneurysms had emergent surgery. Splenectomy and aneurysmectomy were performed in these patients. Profound shock resulted in one mortality. Another two patients receiving elective surgery had uneventful course. No rupture or other complications of the aneurysms occurred in the four patients not undergoing surgery in the period of follow-up (15-160 months). This study demonstrated that splenic artery aneurysm is an uncommon, but clinically important disease. It requires alertness of physicians and radiologists to make a diagnosis. Appropriate management must be applied according to the individualized conditions of the patients.