El aneurisma de la arteria esplénica es una dilatación anormal mayor de 1 cm de diámetro, es el tercer aneurisma intraabdominal más común y el aneurisma visceral más frecuente. Caso clínico: Femenino de 41 años, posterior a accidente automovilístico presenta dolor progresivo en hipocondrio izquierdo; el ultrasonido reporta aneurisma de arteria esplénica y colelitiasis, la angiotomografía confirma aneurisma de arteria esplénica. Se realiza embolización selectiva y colocación de coils, presentando nuevamente dolor abdominal y leucocitosis, nueva angiotomografía con oclusión de arteria esplénica e infarto esplénico, por lo que ameritó la realización de esplenectomía y colecistectomía abierta. Discusión: El 95% de los aneurismas son asintomáticos, el resto pueden presentar dolor en epigastrio y/o hipocondrio izquierdo. Generalmente, son hallazgos incidentales en radiografías, ultrasonidos o tomografías abdominales. Se debe considerar intervención en ciertos casos, siendo el tratamiento de elección la embolización o aplicación de stent por abordaje endovascular. La cirugía convencional se reserva para aneurismas complicados o en caso de ruptura. Conclusión: Actualmente, el tratamiento de elección de los aneurismas esplénicos es el abordaje endovascular. Se presenta un aneurisma a nivel de hilio esplénico que recibió tratamiento endovascular, el cual condicionó infarto esplénico, por lo que ameritó esplenectomía convencional.
In the setting of abdominal blunt trauma, damage to the pancreas is a infrequent complication(0.2 / 3.1%), although when the spleen is damage the lesion to the tail of the pancreas is not as infrequent as the single pancreatic trauma alone. primary closure and repair in an unstable patient can be applied trying to prevent excessive surgical time, but with the risk of developing a pancreatic fistula in the post operative period. in the following case report, we present the case of a young male with splenic and pancreatic trauma, who developed a pancreatic fistula and that required multiple surgeries in order to control this serious complication.26 yo male who under went emergency laparotomy secondary to blunt abdominal trauma, with splenic and distal pancreatic injury, who after multiple surgeries developed type b pancreatic fistulae with impossibility to perform ercp with stent placement as a treatment, so he was referred to our service for surgical evaluation.Patient with adequate surgical evolution discharged 4 days after surgery without biochemical leak evidence, currently on 2nd month of followp as out patient with good clinical evolution.Surgical resection is a feasible as a secondary treatment for non endoscopicaly fitpatients for treatment pancreatic fistulae with good results in third level high volume centers.
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