Aneurysms of anomalous splenomesenteric trunk: Clinical features and surgical management in two cases

Abstract

Aneurysms of the splenic artery that anomalously arise from a splenomesenteric trunk are a rarity. Aneurysmal disease of visceral arteries is found in only 0.2% of the general population. The celiac trunk and superior mesenteric artery (SMA) are involved in less than 10% of all visceral aneurysms. Although rupture seems to occur in 20% to 22% of patients, the related mortality rate can rise as high as 100%. Anomalies of the celiac trunk and SMA, more common than previously claimed, include the splenic artery arising from the SMA, which occurs in only 1% of patients. We present two cases of young patients who had 4-cm aneurysms behind the pancreas that involved an anomalous splenic artery. The first patient required dissection of the entire splenopancreatic bloc through a transverse abdominal incision to excise the aneurysm and repair the SMA. The second patient was treated by the classic approach, through a median incision and by entering the mesenteric root. There do not seem to be reports of similar cases, except for two cases of aneurysms involving the celiomesenteric trunk. The cause of these aneurysms can be attributed to mesenchymal alterations during the embryonic formation of aortic collateral branches. A correct surgical approach to splanchnic aneurysms calls for awareness of potential vascular variations of the arteries and their collateral pathways.

Anatomical variations of the coeliac trunk in the homogeneous Polish population

“…Aneurysms of the common trunk of splenic and mesenteric arteries are very rare. Settembrini et al [27] described 2 cases of 4-cm aneurysms of the splenomesenteric trunk in young patients. Preoperative plan of the surgical treatment of aneurysms should take into account theirs size and anatomical conditions.…”

“…Aneurysms of the abdominal aorta branches are most frequently found during laboratory investigations performed for various clinical purposes [27]. Raptures of the splanchnic aneurysms occur in 20-22% of patients and result in enormous hemorrhage with mortality rate ranging from 35% to 100% [4,9,26,31].…”

Superior Mesenteric Artery Aneurysm Presenting with Chronic Abdominal Pain: A Case Report

“…2,4,19 The resultant mortality rate (between 30 to 90%) is significantly worse than in those patients undergoing repair of intact aneurysms (< 15%). 9,20 The indications for repair include SMA aneurysms with a diameter >2 cm, symptomatic SMA aneurysms, and rapidly growing SMA aneurysms. 21 However, as the natural history of SMA aneurysms is not well-defined, there is still some controversy about the absolute indications for their repair and surgical intervention.…”

Open surgical repair using a reimplantation technique for a large celiac artery aneurysm anomalously arising from the celiomesenteric trunk

“…artery, 19,20 the replaced right or common hepatic artery arising from the SMA, 16 and an anomalous splenic artery arising from the SMA. 17,18 These arteries are considered difficult to dissect because they run into the pancreatic head neural plexus or the dorsal side of the pancreas. 1,2,[16][17][18][19][20] Because of the large incision required and the difficulty in approaching the location for open repair, an endovascular approach has been used for pancreaticoduodenal artery aneurysms despite the celiac axis occlusion.…”