Cross clamping of the supraceliac aorta is effective for bleeding control in ruptured giant splenic artery pseudoaneurysm when proximal and distal control of the splenic artery is not possible: a case report

Mulpuri, Venu Bhargava; Gurijala, Prashanth; Yerolla, Bhaskar Reddy; Ramavath, Krishna; Pandey, Ananya; Ramachandran, Gopinath

doi:10.1590/1677-5449.202102102

Cited by 2 publications

(3 citation statements)

References 11 publications

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“…However, larger pseudoaneurysms (> 5 cm), termed “giant pseudoaneurysms”, are commonly symptomatic, although the risk of rupture seems not to be related to the pseudoaneurysm size [ 7 , 10 , 20 , 25 , 27 ]. SAPs may be detected on exam as a pulsatile mass in the upper left quadrant or epigastric region with associated left upper quadrant pain [ 3 , 4 , 28 ]. If ruptured, they can bleed into the stomach, duodenum, lesser sac, pancreatic duct (hemosuccus pancreaticus), colon, or directly into the peritoneal cavity leading to the symptoms described above [ 9 , 24 , 25 , 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…SAPs may be detected on exam as a pulsatile mass in the upper left quadrant or epigastric region with associated left upper quadrant pain [ 3 , 4 , 28 ]. If ruptured, they can bleed into the stomach, duodenum, lesser sac, pancreatic duct (hemosuccus pancreaticus), colon, or directly into the peritoneal cavity leading to the symptoms described above [ 9 , 24 , 25 , 28 , 29 ]. In our case, the patient presented with acute onset diffuse abdominal pain associated with peritonitis, hypovolemia, and signs of impending hemorrhagic shock.…”

Section: Discussionmentioning

confidence: 99%

“…The risk of rupture of an SAP has been estimated to be near 37%, with a mortality rate of 90% if left untreated [ 5 , 10 , 14 , 20 ]. The hemodynamic status of these patients, location of the SAP, and risk of organ ischemia helps to guide its management.. [ 2 , 3 , 13 , 28 , 30 ]. Historically, open or laparoscopic surgical arterial ligation and splenectomy with or without distal pancreatectomy was the treatment of choice with an excellent success rate, however, it is associated with an increased risk of morbidity and mortality (9% and 1.3%, respectively) [ 3 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous rupture of a mycotic splenic artery pseudoaneurysm secondary to histoplasmosis: a case report

Mirande,

Souza,

Thibodeaux

et al. 2024

surg case rep

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Background A splenic artery pseudoaneurysm is a rare pathology that occurs mainly secondary to pancreatitis, abdominal trauma, peptic ulcers, pancreatic and gastric cancers, and infections. It is best diagnosed using computed tomography angiography and typically treated using endovascular embolization and, in some cases, open or laparoscopic surgery. In this report, we present a case of a ruptured mycotic splenic artery pseudoaneurysm containing Histoplasma capsulatum, which to our knowledge is the first case to report a mycotic splenic artery pseudoaneurysm of this nature. Case presentation We report a case of a 42-year-old white male with past medical history of Hepatitis C and IV drug abuse who presented to the Emergency Department with a 24-h history of severe diffuse abdominal pain. He was tachycardic and peritonitic on exam. Work-up demonstrated leukocytosis and lactic acidosis. Computed tomography of the abdomen and pelvis with intravenous contrast showed hemoperitoneum and active extravasation of contrast from the splenic artery into the splenic hilum, associated with a surrounding hematoma measuring 5.3 × 5.0 cm, concerning for ruptured splenic artery pseudoaneurysm. The patient was taken emergently for exploratory laparotomy, where a large intraperitoneal hematoma was evacuated. A ruptured splenic artery pseudoaneurysm was identified, isolated, and controlled, followed by completion splenectomy. Final pathology demonstrated a 3.0 × 1.3 × 0.3 cm pseudoaneurysm wall and a 14 × 9.5 × 5.5 cm spleen containing multiple necrotizing granulomata positive for the presence of Histoplasmosis species. The patient recovered appropriately and was discharged on post-operative day five. Conclusions This case demonstrates a successful approach to a ruptured mycotic splenic artery pseudoaneurysm resulting in a positive outcome. It is a unique case as it highlights, to our knowledge, the first report of splenic artery aneurysm secondary to Histoplasma capsulatum infection. This report helps further the understanding of the pathophysiology as well as the natural history of mycotic splenic pseudoaneurysms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Spontaneous rupture of a mycotic splenic artery pseudoaneurysm secondary to histoplasmosis: a case report

Mirande,

Souza,

Thibodeaux

et al. 2024

surg case rep

View full text Add to dashboard Cite

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Endovascular and Open Surgical Treatment of Ruptured Splenic Artery Aneurysms: A Case Report and a Systematic Literature Review

Rinaldi,

Brioschi,

Marone

2023

JCM

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Background: Ruptured splenic artery aneurysms (r-SAA), although rare, are burdened by high morbidity and mortality, even despite emergent surgical repair. It is suggested that endovascular treatment can achieve reduction in peri-operative death and complication rates, as in other vascular diseases, but evidence of such benefits is still lacking in this particular setting. We report a case of an r-SAA treated by trans-arterial embolization and then converted to open surgery for persistent bleeding, and we provide a systematic review of current results of open and endovascular repair of r-SAAs. Materials and Methods: A 50-year-old male presenting in shock for a giant r-SAA underwent emergent coil embolization and recovered hemodynamic stability. On the following day, he underwent laparotomy for evacuation of the huge intraperitoneal hematoma, but residual bleeding was noted from the splenic artery, which was ligated after coil removal, and a splenectomy was performed. A systematic literature review of the reported mortality and complications of r-SAA undergoing open (OSR) or endovascular (EVT) treatment was performed using the main search databases. All primary examples of research published since 1990 were included regardless of sample size. The main outcome measures were mortality and reinterventions. Secondary outcomes were post-operative complications. Results: We selected 129 studies reporting on 350 patients—185 treated with OSR and 165 with EVT. Hemodynamically unstable patients and ruptures during pregnancy were more frequently treated with open repair. Overall, there were 37 deaths (mortality: 10.6%)—24 in the OSR group and 13 in the EVTr group (mortality: 12.9% and 7.8% respectively, p-value: 0.84). There were 37 reinterventions after failed or complicated endovascular repair —6 treated with endovascular re-embolization and 31 with laparotomy and splenectomy (22.4%); there were 3 (1.6%) reinterventions after open repair. Overall complication rates were 7.3% in the EVT group (n: 12) and 4.2% in the OSR group (n: 7), and did not require reintervention. No significant differences in overall complications or in any specific complication rate were observed between the two groups. Conclusions: Current results of r-SAA treatment show equipoise terms of morbidity and mortality between open and endovascular repair; however, in case of hemodynamic instability and rupture during pregnancy, open surgery might still be safer. Moreover, endovascular repair is still burdened by a significantly higher rate of reinterventions, mostly with conversions to open surgery.

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Cross clamping of the supraceliac aorta is effective for bleeding control in ruptured giant splenic artery pseudoaneurysm when proximal and distal control of the splenic artery is not possible: a case report

Cited by 2 publications

References 11 publications

Spontaneous rupture of a mycotic splenic artery pseudoaneurysm secondary to histoplasmosis: a case report

Spontaneous rupture of a mycotic splenic artery pseudoaneurysm secondary to histoplasmosis: a case report

Endovascular and Open Surgical Treatment of Ruptured Splenic Artery Aneurysms: A Case Report and a Systematic Literature Review

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