Berry splenic artery aneurysm rupture in association with segmental arterial mediolysis and portal hypertension

Abstract

A rare case of berry splenic artery aneurysm (SAA) rupture associated with segmental arterial mediolysis (SAM) and portal hypertension is reported. A 66-year-old woman, diagnosed as having liver cirrhosis and portal hypertension 6 years earlier, suddenly developed a lancinating pain in the upper abdomen and lost consciousness. She recovered consciousness while being transferred to hospital by ambulance. During the investigations, her level of consciousness suddenly deteriorated. Ultrasonography showed a massive intraperitoneal hemorrhage, and she died 5(1/2) h after admission. On gross examination at autopsy it was not possible to find the rupture point of the vessel because the pancreas was embedded in a massive hematoma. However, careful dissection of the pancreatic tail after fixation revealed a berry aneurysm measuring 0.8 cm in diameter in a branch adjacent to the bifurcation in the distal third of the main splenic artery. Microscopic examination detected a rupture of the aneurysm. The histology of the arterial wall proximal to the aneurysm showed typical SAM. In general, berry SAA caused by SAM is rare and unlikely to rupture. The SAA in the present case likely occurred and ruptured due to the combination of SAM and portal hypertension.

Spontaneous ruptured splenic artery aneurysm: a case report

“…Other causes of ruptured splenic artery aneurysms include congenital causes such as anomalous origin [8], Berry aneurysm [9] and arteriovenous malformation [10] and acquired conditions such as pancreatitis [11] and possible toxic causes resulting in vessel wall damage [12]. …”

Aneurysms of the renal arteries associated with segmental arterial mediolysis in a case of polyarteritis nodosa

“…The disease most commonly involves visceral arteries such as the superior or inferior mesenteric, splenic, hepatic and renal arteries in the elderly 3,9 . The patients usually complain of sudden abdominal pain, abdominal distention, vital abnormalities and unconsciousness 9–11 . It has also been reported that several intracranial aneurysms were due to SAM 12–14 .…”

“…It has also been reported that several intracranial aneurysms were due to SAM 12–14 . The etiology of SAM is poorly understood, but it is thought that vasospasm is relevant 1,3,4,7,10 . Complication with autoimmune diseases such as microscopic polyangiitis (MPA) has also been reported 15,16 .…”

“…3,9 The patients usually complain of sudden abdominal pain, abdominal distention, vital abnormalities and unconsciousness. [9][10][11] It has also been reported that several intracranial aneurysms were due to SAM. [12][13][14] The etiology of SAM is poorly understood, but it is thought that vasospasm is relevant.…”

Giant Splenic Artery Pseudo Aneurysm Masquerading as Bleeding Per Rectum - A Rare Case

“…Most of the aneurysms are caused by degenerative atherosclerosis, portal hypertension secondary to liver cirrhosis, pancreatitis, pregnancy, congenital causes such as anomalous origin, Berry aneurysm, arteriovenous malformation [2,9,7,11,5,10].…”