The therapeutic challenge of giant splenic artery aneurysm: a case repport

Abstract

Giant splenic artery aneurysm is a rare condition that represents an eminent life threatening for the patient, requiring, therefore, urgent surgical correction. A 61-year-old woman, former smoker, hypertensive, hypercholesterolemic and multipara sought our service because of a large tumor in the mesogastrium, which was an abdominal ultrasound finding. Despite the size of the tumor, the patient was asymptomatic. The angiotomography and the magnetic resonance image of the abdomen were suggestive of giant splenic artery aneurysm with more than 10cm in diameter that was confirmed by an angiography. She underwent surgery, open splenectomy, and partial aneurysmectomy. The approach of the celiac artery, which was ligated, was only possible with medialvisceral rotation because there was no possibility to view it through the anterior access. The histopathological test of aneurysmatic wall revealed atheroma plaques in the intima. The patient progressed without complications and she was discharged cured. In general, giant splenic artery aneurysms are symptomatic, however, as in the case we report, it may be asymptomatic and found in abdominal imaging exam. Although less invasive Interventional methods exist, such as laparoscopy and endovascular techniques, they were considered inappropriate in this case. Conventional open surgery should be the therapy of choice for a giant splenic artery aneurysm.

Laparoscopic splenectomy in the treatment of splenic artery aneurysm - case report and literature review

“…According to the literature data, 10% of gigantic SAAs (> 5 cm) are associated with liver cirrhosis. Around 2.5% of patients have portal hypertension [2,6,13]. Pancreatitis is reported as the main risk factor for the emergency laparotomy to treat sudden rupture and bleeding from splenic artery pseudoaneurysms [6].…”

“…Around 2.5% of patients have portal hypertension [2,6,13]. Pancreatitis is reported as the main risk factor for the emergency laparotomy to treat sudden rupture and bleeding from splenic artery pseudoaneurysms [6]. Pancreatic enzymatic autodigestion can cause weakening of the splenic artery wall architecture leading to pseudoaneurysm formation.…”

“…Open or laparoscopic splenectomy is the treatment choice for aneurysms located in the splenic hilum or immediately next to the hilum. Another option is endovascular management with stent placement or arterial embolization [6,7,14,15]. The aim of surgical treatment should be the treatment of aneurysm with the splenic preservation or the preservation of a sufficient part of the organ (not less than 25% of the volume), enough to perform the immune function.…”

“…There are several treatment modalities for SAAs: open resection, splenectomy, as well as endovascular treatment (graft, stent, or embolization), depending on the patient's suitability for a particular type of treatment [6,7].…”