Severely Calcified True Aneurysm: A Thought-Provoking Case of Solitary Origin and Postoperative Management

Abstract

Patient: Male, 70 Final Diagnosis: Splenic artery aneurysm Symptoms: Asymptomatic Medication: — Clinical Procedure: Surgery and Endoscopy Specialty: Surgery Objective: Unknown ethiology Background: Visceral arterial aneurysms are rare. Most splenic arterial aneurysms (SAAs) are saccular and are in the distal third of the splenic artery. Suggested major causes of SAAs are atherosclerosis, pregnancy, and inflammation. We report the case of a patient who with a SAA extending almost the full length of his splenic artery. Case Report: A solitary true aneurysm that extended almost the entire length of the splenic artery was incidentally detected in an asymptomatic 70-year-old male patient with a history of myasthenia gravis and diabetes mellitus. His SAA was severely calcified, but other arteries showed no calcification. The aneurysm had been slightly enlarged toward the celiac artery for 2 years, and aneurysmectomy and splenectomy were performed. Vascular clips were carefully placed at the intact splenic artery without disturbing arterial flows from the celiac artery. Arterial branch from the SAA was ligated at an intact area, and the pancreatic capsule was densely adherent with the calcified aneurysm wall. The pancreas was preserved, although the pancreatic parenchyma was widely exposed during aneurysmectomy. Pathological examination revealed no atherosclerotic changes. Postoperatively, a pancreatic fistula developed, which was treated by placing an intraperitoneal drain and retrograde pancreatic drainage tube. Nevertheless, the intractable pancreatic fistula triggered a bacteriogenic infection, resulting in intraperitoneal abscess. Continuous local lavage via transnasal continuous infusion and endoscopic transgastric drainage was performed, until the fistula closed. He was healthy at 9 months after surgery. Conclusions: A SAA that had the rare form and solitary origin was treated. Continuous local lavage has a therapeutic potential for a pancreatic juice-related bacteriogenic complication.

Spontaneous rupture of a large splenic artery aneurysm in a 59-year-old male patient with pemphigus vulgaris: a case report

“…SAA has been most frequently reported in females, with a 4:1 female-to-male ratio [3][4][5], although rupture may occur more frequently in men [6]. The majority of SAAs (> 90%) are asymptomatic and are discovered incidentally during imaging studies [7]. SAAs are also more common after the sixth decade of life, with 80% of cases occurring in patients over 50 years of age [1], similar to our case.…”

Spontaneous Rupture of a Huge Splenic Artery Aneurysm: A Case Report

“…It is more common in females, with a 4: 1 female-tomale ratio [7][8][9], but men are more likely to have a rupture. [10] Most SAAs (>90%) remain asymptomatic and are discovered incidentally on imaging studies [11]. SAAs are also more common after the 6 th decade of life, with 80% of cases seen in patients above 50 years of age [12], indicating the age/diseaserelated degeneration that was absent in our case.…”

Fatal arterial hemorrhage after pancreaticoduodenectomy: How do we simultaneously accomplish complete hemostasis and hepatic arterial flow?

“…The HA ( i.e. , the CHA, PHA, and lobular branches) is the second most frequent site of visceral pseudoaneurysms, and the splenic artery is generally the most common[ 47 ]. Pseudoaneurysms of the HA are usually iatrogenic[ 2 , 16 , 30 , 44 ] but may also be associated with localized infection or trauma[ 30 ].…”

“…, the GDA stump)[ 19 , 43 ], although both the proximal and distal sides of the GDA should be completely embolized[ 19 ]. To prevent recanalization and rebleeding, all arterial flows to the pseudoaneurysm should be completely interrupted[ 19 , 44 , 47 , 48 ]. Although the pancreaticoduodenal arcade is removed during PD, arterial arcades remain in the pancreatic remnant (Figure 1 )[ 29 , 47 ].…”

“…To prevent recanalization and rebleeding, all arterial flows to the pseudoaneurysm should be completely interrupted[ 19 , 44 , 47 , 48 ]. Although the pancreaticoduodenal arcade is removed during PD, arterial arcades remain in the pancreatic remnant (Figure 1 )[ 29 , 47 ]. Recanalization via the collateral circulation has been reported after TAE[ 29 ]; however, transcatheter techniques ( e.g.…”