Rupture Of Splenic Artery Aneurysm Research Articles

A case of acute heart failure due to infective endocarditis in patient with liver and splenic abscesses after coil embolization for impending rupture of splenic artery aneurysm

A case of acute heart failure due to infective endocarditis in patient with liver and splenic abscesses after coil embolization for impending rupture of splenic artery aneurysm

An Institutional Review of Splenic Artery Aneurysm in Childbearing-Aged Females and Splenic Artery Aneurysm Rupture During Pregnancy. Is Screening Justified?

To determine the prevalence of splenic artery aneurysm (SAA) in women of childbearing age and the incidence of peripartum rupture to ascertain a possible benefit of screening this potentially high-risk population. Patients diagnosed with SAA over a 6-year period were collected from a single institutional medical records database. Inclusion criteria included female gender and age between 15 and 49 years. The number of abdominal computed tomography studies performed on our study population during the study period was compared to the number of detected SAAs. The number of deliveries at our institution during the study period was compared to the number of peripartum SAA ruptures. The resultant data were used to calculate the prevalence of SAA in childbearing-aged females and the incidence of SAA rupture during pregnancy. The prevalence of SAA in childbearing-aged females and incidence of rupture during pregnancy were less than 0.1%. Radiologic screening of all childbearing-aged females is not warranted, but identification of those at greater risk of harboring an asymptomatic SAA, along with the early institution of treatment according to current guidelines, may prevent maternal and fetal mortality in the rare event of SAA rupture during pregnancy.

Simulation Case: Spontaneous Rupture of Splenic Artery Aneurysm, an Uncommon Cause of Abdominal Pain and Hypotension

Abstract This resource is a simulation case based on an actual patient encounter. It includes actual images from studies as well as actual values of laboratory studies. The goal is to provide resid...

Massive Upper Gastrointestinal Bleeding due to Rupture of Splenic Artery Aneurysm Caused by a Hypernephroma

Purpose: Upper endoscopy can sometimes be non diagnostic in the patient who presents with acute massive upper gastrointestinal bleeding. This can be due to the large amount of blood in the stomach that can impair visualization of the walls of the stomach. In such patients, early intervention with angiography can be a safe and life saving solution. We present here the case of a 61 year old female who presented to the emergency room with large amounts of hematemesis. Blood pressure was 59/29 mm Hg. Hemoglobin was 6.6 gm%. She underwent an urgent upper endoscopy that showed large amount of blood in the stomach. A bleeding site could not be located and the patient was sent to interventional radiology for an urgent angiography. The celiac axis was catheterized and contrast was seen to be leaking from an aneurysm in the mid main splenic artery. A coaxial micro catheter was placed and the splenic artery distally and proximally was embolized with coils trapping the area of bleeding between the coils. Angiography also showed tangles of vessels extending into the left upper quadrant likely representing neovascularity. A CT scan of the abdomen was therefore done that showed a large mass in the upper pole of the left kidney highly suspicious for renal cell carcinoma. A repeat upper endoscopy done 3 days later showed a large area of ulceration in the posterior wall of the greater curvature of the stomach with small amounts of calcification, likely from the splenic artery aneurysm that was coiled. At surgery, the renal mass was seen to be causing a mechanical obstruction of the splenic artery. In summary, the patient developed renal cell cancer that caused a mechanical obstruction to the splenic artery resulting in aneurysm formation. The splenic artery aneurysm caused the gastric bleeding by rupturing into the posterior wall of the stomach. Discussion: Splenic artery aneurysms are rare. Increased velocity of blood flow through the splenic artery may be an etiological factor. Endovascular embolization is a viable treatment for these patients with an 80-92% success rate. A review of the literature did not show a similar case of a renal mass causing mechanical obstruction and aneurysm formation in the splenic artery and subsequent rupture into the stomach.Figure: No Caption available.

Rupture d’un anévrisme de l’artère splénique en fin de grossesse : à propos d’un cas et revue de la littérature

Haemorrhages during pregnancy may have a non-obstetrical origin, the pregnancy itself favoring some specific aetiologies because of pregnancy-related physiological modifications. These non-obstetrical haemorrhages are rare but are associated with a high maternal and foetal mortality. The prognosis depends on an early diagnosis and a multidisciplinary approach. We report the case of a patient who had a caesarean section for suspicion of acute foetal distress during which was found a large intraperitoneal bleeding due to rupture of an unknown splenic artery aneurysm. We discuss the principal causes of non-obstetrical intra-abdominal bleeding, including subcapsular liver haematoma, rupture of uterine vessels and rupture of splenic artery aneurysm, with a specific focus on this last aetiology.

Aneurisma de artéria esplênica corrigido por embolização com molas

O aneurisma da artéria esplênica é uma entidade clínica rara, embora seja o mais frequente entre os aneurismas viscerais, sendo encontrado em 0,8% da população. Apresenta-se mais frequentemente em mulheres, na proporção de 4:1, e raramente provoca sintomas ou sinais clínicos. Desenvolve-se de forma assintomática e, na maioria dos casos, é diagnosticado por meio de exames indicados para elucidar queixas clínicas decorrentes de outras doenças ou quando apresenta complicações por vezes fatais, como a rotura. A possibilidade de rotura dos aneurismas de artéria esplênica com diâmetro inferior a 2 cm é baixa; entretanto, os que apresentam diâmetro igual ou maior que 3 cm são usualmente encaminhados para tratamento cirúrgico, devido ao alto risco de rotura. O tratamento eletivo é indicado nos casos não complicados, sendo a embolização com molas um método interessante por evitar o tratamento cirúrgico convencional.

Clairvoyants

Breathing hard and afraidthe fat man catalogues his pain in short phrases.He sweats.We circle the stretcher pretending what we do is meaningful.We make reassuring commentsto the family.When the tests are completewe still don’t know what to call it.But we know it when we see it.ED physician’s blink response;highly accurate:This patient is trying to die.The man is put in the hospital.Days later a diagnosis:“Splenic artery aneurysm rupture.”We don’t know about that ….But we despise our clairvoyance: he died.

Haemosuccus pancreaticus due to true splenic artery aneurysm: a rare cause of massive upper gastrointestinal bleeding.

“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.

Rupture of Splenic Artery Aneurysm in Pregnancy

Splenic artery aneurysms are an uncommon form of vascular disease, which have a significant potential for rupture, most commonly associated with pregnancy, typically presents as sudden, unexpected death. As a consequence, the initial recognition and diagnosis of splenic artery aneurysm rupture take place only at autopsy. This report presents 2 cases of sudden death resulting from splenic artery aneurysm in a pregnant woman and a postpartum woman, respectively. The former splenic artery aneurysm were measuring 1 cm in diameter and the latter splenic artery aneurysm 5.5 x 5 x 2 cm in size. Histologic examination of the both vessels wall showed severe morphologic changes of degeneration together with an attenuation of arterial internal elastica. To our knowledge, splenic artery aneurysm in pregnant woman is unusual vital disease. It is essential that obstetricians are alert to the prodromal and catastrophic symptoms of splenic artery aneurysm. Early recognition and prompt management, including early resected electively, are vital to the survival of both mother and fetus.

Management of splenic artery aneurysms in liver transplant recipients

We read with great interest the recent article1 describing Moon et al.'s experience with splenic artery aneurysms (SAAs) in adult living donor liver transplant recipients. The authors retrospectively reviewed 44 liver transplant recipients with SAAs out of 310 patients. Interestingly, portosystemic shunts were present in all patients, with the diameter of these collaterals being the only significant factor for the presence of SAAs. Three patients presented with a ruptured aneurysm in the postoperative period, and 2 of these had undergone splenic artery ligation at the time of transplantation. After this experience, the authors changed their policy, and they now recommend aggressive treatment of SAAs, either surgical or radiological, within 24 hours of transplantation, before or afterward. Nevertheless, other facts are also worth noting in this report. First, despite the recommendation of proximal and distal ligation of the splenic artery for a unique extrasplenic aneurysm, only proximal ligation was possible in 6 patients, and 2 of them suffered an SAA rupture. Second, 32 patients with SAAs ranging from 10.5 to 25 mm were not treated during the study period; they had no complications, and they experienced a significant reduction of the mean aneurysm diameter after 1-year of follow-up. Our experience is similar to the latter finding. From February 1996 to May 2009, 786 liver transplants were performed in our institution with whole grafts from deceased donors. In a retrospective analysis, we found 7 recipients with SAAs diagnosed during the transplant assessment. All patients had a unique SAA in the distal third of the splenic artery with a diameter ranging from 10 to 30 mm. No prophylactic treatment was indicated, and no complications occurred. After a median follow-up of 106 months (range = 5-132 months), the size of the SAAs decreased from 30 to 20 mm in 2 patients, whereas the others remained unchanged. The incidence of SAAs in our series was probably underestimated because of the retrospective analysis; however, we have had no cases of urgent reoperation or death due to SAA rupture. Although there seems to be a general consensus to treat symptomatic SAAs, asymptomatic SAAs greater than 20 mm, and those in liver transplant candidates,2, 3 this appears to be based only on reports of complicated aneurysms, whereas the natural history of untreated SAAs in transplant patients remains poorly understood. Three reports of untreated SAAs in no transplant setting were revised in a recent report, and only 1 of 191 patients suffered spontaneous rupture after a mean follow-up that ranged from 15 to 75 months.2 Nevertheless, abdominal surgery is considered to be a risk factor for SAA rupture,4 and the reported incidence of this complication is 2% to 4% in the posttransplant period.1, 3 Moreover, with respect to the treatment of SAAs in liver transplant candidates during the perioperative period, some facts must be considered: (1) splenectomy during liver transplantation might be difficult and a cause of severe intraoperative complications1; (2) distal splenic artery ligation for single extrasplenic aneurysms is usually difficult to accomplish because of technical difficulties; (3) proximal ligation alone might be enough to prevent the rupture of extrasplenic aneurysms but not the rupture of hilar and intrasplenic ones, which unfortunately are the most common1; and (4) aneurysm embolization or complete arterial embolization in hilar and multiple aneurysms seems to be very effective, although complications are not uncommon.1, 3, 5 In summary, the incidence of SAA rupture in liver transplant patients is not high, adequate surgical treatment is frequently challenging, and arterial splenic embolization is not free from complications. In this scenario, the aggressive treatment of all liver transplant candidates with SAAs is debatable. In our opinion, more studies are needed to determine the risk factors related to the rupture of SAAs in liver transplant recipients and to define a group of patients who may benefit from preventive treatment. Until then, we are very reluctant to treat all SAAs in liver transplant candidates but instead would prefer to treat them only when they are symptomatic, are greater than 30 mm, or show enlargement during a close follow-up with repeated computed tomography angiograms. Mikel Gastaca*, Alberto Ventoso*, Andrés Valdivieso*, Jorge Ortiz de Urbina*, * Hepatobiliary Surgery and Liver Transplantation Unit University Hospital of the Cross at Bilbao Baracaldo, Vizcaya, Spain.

A Patient with Splenic Artery Aneurysm Rupture and the Importance of Rapid Sonography in the ED

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.

Splenic artery aneurysm: a diagnostic challenge in the setting of extensive portal venous collaterals

We present a 16-year-old boy with autoimmune liver disease and longstanding portal hypertension in whom a CT arteriogram demonstrated a large aneurysm arising from the distal, extra-parenchymal portion of the splenic artery. Because of its location adjacent to multiple venous collaterals, the aneurysm was indistinguishable from splenic varices on initial imaging with Doppler sonography and on portal venous-phase CT. There is an increased risk of rupture of splenic artery aneurysms in the post-liver transplant period, with high associated mortality, and therefore diagnosis of splenic artery aneurysm prior to liver transplantation is clinically important. It is quite possible that the diagnosis of splenic artery aneurysm in this case would have been missed in the absence of dedicated arterial-phase imaging. As radiologists strive to reduce radiation exposure in children, this case highlights a potential diagnostic pitfall of both Doppler sonography and venous or single-acquisition arterial/venous-phase CT angiogram in children with venous collaterals and an undiagnosed splenic artery aneurysm.

Management in an emergency department of a splenic artery aneurysm

Although splenic artery aneurysm is a relatively rare clinical entity, it is the second most common abdominal splanchnic artery aneurysm (SAAs), accounting for approximately 60% of all SAAs [1]. The pathogenesis of the splenic artery aneurysm appears unclear, but seems most likely due to degeneration of the vessel wall media from excessive splanchnic blood flow [1]. Asymptomatic splenic artery aneurysm rupture represents an uncommon cause of hypovolaemic shock in the emergency department (ED). Up to 25% of these aneurysms may be complicated by erosion or rupture, with a mortality ranging between 25 and 70% [1]. This aneurysm is often detected on imaging studies such as an ultrasound study or computed tomography (CT scan). Treatment can be either surgical or interventional radiology-based, and should be considered in all patients with symptoms related to the lesions [2]. In this paper, the management of a splenic artery aneurysm, discovered by an abdominal ultrasound study in an apparently healthy woman, is discussed. A 71-year-old woman was admitted to our medical ED, because of a month long abdominal pain occurring after meals, suggesting cholecystitis. She denied any history of hypertension, diabetes, cirrhosis, intestinal diseases or prior abdominal surgeries. The physical examination and laboratory tests were normal. In our case the abdominal symptoms are not specific for splenic artery aneurysm, because this latter commonly presents left upper quadrant or epigastric pain radiating to the left shoulder. There are non-correlations between size of the aneurysm and abdominal symptoms, confirming the evidence that these aneurysms are frequently asymptomatic and only incidentally discovered. However, their incidence is now more evident because of the availability of imaging. The patient underwent an abdominal ultrasound examination that showed a large hypoechogenic mass of 2.5 cm of diameter in the left side of the abdomen (near the splenic hilum region); no gall stones were found during this examination. The colour Doppler study showed the presence of blood flow suggesting a possible splenic artery aneurysm. Computed tomography (CT) angiography showed a voluminous saccular dilatation of the splenic artery in the middle tract (Fig. 1a). It is recommended that an asymptomatic aneurysm larger than 3 cm is an indication for surgery, while those between 1 and 2 cm in diameter should be monitored closely with imaging studies every 6 months or so, avoiding hospital admission. However, mortality after emergency surgery is as high as 40%, compared with a negligible mortality after elective management [3]. A selective catheterisation of the splenic artery by a 4-F-SIM-1 catheter (Cordis Europa, Roden, Olanda) led to the embolisation of the aneurysm using metallic coils (IMWCE), coaxially inserted both upstream and downstream of the aneurysm. A. Mazza D. Montemurro S. Zamboni Department of Internal Medicine, Rovigo General Hospital, Rovigo, Italy

Characteristics and management of splenic artery aneurysms in adult living donor liver transplant recipients

Splenic artery aneurysms (SAAs), occurring in 7% to 17% of patients with cirrhosis, often result in catastrophic rupture after liver transplantation. We had experienced 3 cases of ruptured SAAs after adult living donor liver transplantation (LDLT), and we then performed this study to find risk factors for coexisting SAAs in liver transplant candidates with cirrhosis and to propose ideal approaches for them. Preoperative and postoperative computed tomography angiograms and axial views were reviewed for 310 adult LDLT recipients who had cirrhosis from January 2004 to August 2005. The recorded variables were the preoperative diagnosis, the presence of SAA and its characteristics, the splenic artery (SA) diameter, and the presence and size of portosystemic collaterals. Devastating SAA rupture accompanied by hypovolemic shock occurred on postoperative days 6, 82, and 8, respectively, and it was treated emergently by embolization in cases 1 and 2 and by splenectomy in case 3. Cases 1 and 3 recovered well, but case 2 died of an unrelated cause with a long hospital stay. The incidence of SAA during the study period was 14.2% (44/310), and the size was 16.6 +/- 5.7 mm. Most SAAs were single (70.6%, 31/44) and were located in the distal one-third of the SA (82.4%, 36/44). Large portosystemic collaterals demonstrating longstanding severe portal hypertension were significantly correlated with the occurrence of SAAs. Nine patients with SAAs were preventively treated by proximal ligation (n = 4) intraoperatively and by embolization (n = 5) 1 day before or after LDLT. No patient showed severe postembolization syndrome. In conclusion, a careful preoperative evaluation of SAAs by high-resolution 3-dimensional computed tomography in liver transplant candidates, especially in those showing large portosystemic collaterals, is merited. Preventive treatment should be encouraged regardless of the size in order to avoid severe morbidity and mortality related to SAA rupture, and methods such as radiological and surgical interventions need to be individualized according to the location and number of SAAs.

A rare clinic presentation of abdominal pain: rupture of splenic artery aneurysm: a case report

BackgroundSplenic artery aneurysms (SAA) are uncommon but the most common visceral artery aneurysm. Splenic artery aneurysms are important to recognize because up to 25% may be complicated by rupture and the mortality rate after rupture is between 25% and 70%.Case reportWe present a patient who have abdominal pain. Previously healthy 22-year-old female admitted to emergency department with abdominal pain. Her physical examination reveals only left upper quadrant tenderness. Suddenly she developed hypovolemic shock. On emergent laparotomy massive blood collection within peritoneal cavity and retroperitoneal space at the left upper quadrant was detected. The source of bleeding was evident as rupture of splenic artery aneurysm. Splenectomy was performed following the ligation of splenic artery proximal to lesion. On the tenth day she was discharged from the hospital with complete recovery.ConclusionIt is important to remember rupture of splenic artery aneurysm in patients with abdominal pain and hypovolemic shock status.

Rupture of splenic artery aneurysm during early pregnancy: a rare and catastrophic event

Spontaneous rupture of splenic artery aneurysm during pregnancy is a rare, life-threatening event with a catastrophic prognosis. Splenic artery aneurysm, known to be more frequent in women, especially among multiparous ones, is generally asymptomatic until rupture. Because of increased blood flow and hormonal modifications, this rupture occurs frequently during pregnancy, most often at the end of the third trimester. We present the case of a second parous woman in early pregnancy with a rupture of splenic artery aneurysm initially diagnosed as a complicated ectopic pregnancy, which profoundly modifies surgical treatment. Through this case report, we want to draw attention to the fact that even if complicated ectopic pregnancy is much more frequent, ruptured splenic artery aneurysm (SAA) needs to be considered as a part of differential diagnosis of hemoperitoneum during the first trimester as well.

The clinical feature, diagnosis and management of splenic artery aneurysms in liver transplant patients

To summarize the clinical feature of splenic artery aneurysms (SAA) in OLT recipient, and review the experience in diagnosis and management. The clinical data, results of four-phase CT scanning and CT angiography of 450 recipients, who underwent OLT from December 2001 to December 2003 were analyzed statistically. Twenty of 450 recipients were diagnosed as SAA, the incidence was about 4.4%. Nineteen of them were diagnosed by four-phase CT scanning. Fifteen patients did not receive any treatment for SAA during OLT, but two of them suffered SAA rupture after OLT, among which one died of hemorrhagic shock although emergency operations were performed. The five patients, who were performed splenectomy with SAA resection during transplantation, recovered successfully after OLT, and their grafts' function was satisfactory. Morbidity of SAA is higher in patients of liver cirrhosis. Four-phase CT scanning can diagnose SAA exactly. In the early period post-OLT, SAA rupture happens frequently, so SAA resection should be performed during transplantation.

Rupture of multiple splenic artery aneurysms: A common presentation of a rare disease with a review of literature

The splenic artery is the most frequent site of visceral arterial aneurysms. Usually a splenic artery aneurysm occurs as a single event; rupture is frequent, sometimes occurring as the first symptom and is sometimes fatal. This article presents a case of ruptured multiple splenic artery aneurysms—the symptoms and signs, operative and perioperative management, as well as a literature review of this clinically important entity.

Spontaneous ruptured splenic artery aneurysm: a case report

Splenic artery aneurysms are rare. We discuss a case of a 58-year-old gentleman presenting with collapse and shock secondary to spontaneous splenic artery aneurysm rupture. Patient underwent laparotomy and splenectomy then discharged home within a week of presentation.

Intrapancreatic rupture of a splenic artery aneurysm during pregnancy – a rare case report with fetal and maternal survival

Rupture of a splenic artery aneurysm (SAA) during pregnancy is a rare and severe condition. A 35-year-old woman at 34 weeks' gestation came to our observation for acute abdominal pain. After being diagnosed with intra-pancreatic SAA rupture, she was delivered of a live fetus by cesarean section. This is a rare case with both fetal and maternal survival.