Giant splenic artery aneurysm: A rare but potentially catastrophic surgical challenge

Yadav, Siddharth; Sharma, Piyush; Singh, Pintu Kumar; Punia, Sudhanshu; Desai, Pragnesh; Anjan, Anjani kr; Jain, Sunil K.

doi:10.1016/j.ijscr.2012.06.010

Cited by 42 publications

(70 citation statements)

References 17 publications

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“…In true aneurysm, the aneurismal wall is composed of all the three layers, that is, the intima, media, and adventitia. Whereas, in a pseudoaneurysm, there is a breach in the vessel wall along with an extravascular hematoma bounded by surrounding tissue [1]. Visceral arterial aneurysms are a rare entity; they are often asymptomatic, incidental findings in computed tomography (CT) and magnetic resonance imaging (MRI) [2].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and predictive factors for development of splenic artery aneurysms in cirrhosis

Kaya

Baran

Güya

et al. 2016

Indian J Gastroenterol

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Section: Introductionmentioning

confidence: 99%

“…Greater availability and increased use of advanced imaging including CT, MRI, ultrasound, and arteriography have led to the increased incidental detection of asymptomatic visceral aneurysms [2][3][4]. The common site of visceral aneurysm is the abdominal aorta followed by iliac arteries and then splenic artery [1,5].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and predictive factors for development of splenic artery aneurysms in cirrhosis

Kaya

Baran

Güya

et al. 2016

Indian J Gastroenterol

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“…It is usually located in the distal part of splenic artery. Larger aneurysms like in our patient are seldom reported [1,3,6]. The aneurysm generally develops on the main splenic artery commonly on its distal third or on intrasplenic branches.…”

Section: Discussionmentioning

confidence: 47%

Multiple Splenic Artery Aneurysms: A Rare Cause of Extrahepatic Portal Hypertension and Massive Splenomegaly

Aroor

Raghuraj

et al. 2014

JCDR

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A 39-year-old female presented with one year history of dragging abdominal discomfort and fatigability of six months duration. She was non-alcoholic and had no other medical illness. General physical examination was unremarkable and abdominal palpation suggested splenomegaly of 10 cms below left coastal margin, which was firm and nontender. There was no ascites or hepatomegaly. Examination of other systems was unremarkable.Investigations revealed normal complete blood counts, urine analysis, liver and renal function tests and peripheral smear study. Investigation reports are shown in [Table/ Fig-1]. Ultrasonography (US) with color doppler of abdomen revealed splenomegaly, normal liver echotexture and cavernous transformation of portal vein with multiple spleno-renal collaterals. ECG and echocardiography was normal. Upper gastro-intestinal endoscopy showed grade 1-2 esophageal varices with portal hypertensive gastropathy. Multidetector Computed tomography (MDCT) abdomen revealed multiple aneurysms in the distal half of splenic artery, the largest one measuring (5.1cmx5.8cmx4.4cms) with dilated and tortuous course of the proximal splenic artery with multiple collaterals along the course of splenic and portal vein b,. Wall calcification and organized thrombus was seen in few of the aneurysms at the splenic hilum. DisCussionSplenic artery aneurysms (SAA) are the most common visceral aneurysms, accounting for up-to 60% of cases [1,2]. Splenic artery is the third most common site for intra-abdominal aneurysm after aorta and iliac artery [2]. It has an incidence of 0.01-0.2%, females being more commonly affected (4:1). SAA presenting as extrahepatic portal hypertension is rare [1,3]. Here we report a patient with multiple splenic artery aneurysms presenting as extrahepatic portal hypertension and massive splenomegaly. SAA are very rare with a varied prevalence of 0.01%-10.4% [4]. SAAs are associated with several conditions, including pregnancy, degenerative atherosclerosis, portal hypertension, medial fibrodysplasia, arteritis, collagen vascular disease, α 1-antitrypsin deficiency, and pancreatitis [2]. Hormonal changes during pregnancy, increased blood volume and cardiac output causing portal congestion are the proposed mechanisms of SAA in pregnancy internal medicine section [5]. SAA are usually single, isolated and <3cms in size. It is usually located in the distal part of splenic artery. Larger aneurysms like in our patient are seldom reported [1,3,6]. The aneurysm generally develops on the main splenic artery commonly on its distal third or on intrasplenic branches. Multiple Splenic Artery Aneurysms: A Rare Cause of Extrahepatic Portal Hypertension and Massive Splenomegaly aBstRaCtA 39-year-old nulliparous female was admitted with massive splenomegaly. Computed tomography of abdomen revealed multiple aneurysms in the distal half of the splenic artery. Splenic artery aneurysms are rare in nulliparous women and most cases are reported in females with a past history of pregnancy. Splenic artery aneurysms, though very...

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“…The aneurysm mostly lies at the distal portion of splenic artery and near the splenic hilum and true aneurysm originating from the initial part of splenic artery is extremely rare [6] . The size of an aneurysm is usually 2-5 cm, and few are larger than 10 cm [4,11] . Aneurysms tend to be fusiform, capsular, spherical and even bead-like shape [12,13] .…”

Section: Discussionmentioning

confidence: 99%

Aneurysm resection and vascular reconstruction for true aneurysm at the initial segment of splenic artery

Chun-xi

Han

Liang

et al. 2015

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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The aneurysms at the initial segment of splenic artery are rare. This paper aimed to investigate the methods to treat the true aneurysm at the initial segment of splenic artery by aneurysmectomy plus vascular reconstruction. Retrospectively reviewed were 11 cases of true aneurysm at the initial segment of splenic artery who were treated in our hospital from January 2000 to June 2013. All cases were diagnosed by color ultrasonography, computer tomography (CT) and angiography. Upon resection of the aneurysm, the auto-vein transplantation was performed in situ between the hepatic artery and the distal part of the splenic artery in 1 case; the artificial vessel bypass was done between the infra-renal aorta and distal portion of the splenic artery in 7 cases; the splenectomy was done in 2 cases; the splenectomy in combination with ligation of multiple small aneurysms were performed in 1 case. All cases were cured and discharged from the hospital 10-14 days after operation. A 1-14 year follow-up showed that 9 cases survived, and 2 cases died, including 1 case who died of acute myocardial infarction 2 years after aorta-splenic artery bypass operation and 1 case who died of acute cerebral hemorrhage 5 years after aneurysm resection and the splenectomy. Among 6 cases receiving aorta-splenic artery bypass, 1 gradually developed stenosis at anatomosed site, which eventually progressed to complete occlusion 2 years to 6 years after operation, without suffering from splenic infarction because the spleen was supplied by the short gastric vessel and its collaterals. The other 5 cases receiving aorta-splenic artery bypass and 1 case undergoing autologous vascular transplantation did not develop stricture or pseudoaneurysm at the stoma. Our study showed that the aneurysmectomy plus vascular reconstruction is a better treatment for aneurysm at the initial segment of splenic artery.

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Giant splenic artery aneurysm: A rare but potentially catastrophic surgical challenge

Abstract: Giant splenic artery aneurysms, although rare, should be considered in patients presenting with left upper abdomen pulsatile masses. Clinical suspicion followed by emergent management is necessary to prevent potentially life threatening complications.

Cited by 42 publications

References 17 publications

Prevalence and predictive factors for development of splenic artery aneurysms in cirrhosis

Prevalence and predictive factors for development of splenic artery aneurysms in cirrhosis

Multiple Splenic Artery Aneurysms: A Rare Cause of Extrahepatic Portal Hypertension and Massive Splenomegaly

Aneurysm resection and vascular reconstruction for true aneurysm at the initial segment of splenic artery

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