Splenic Artery Aneurysm of the Hepatosplenomesenteric Trunk

Abstract

A splenic artery aneurysm is the most frequently observed visceral artery aneurysm, with an incidence of 40%-60% of all visceral aneurysms. [1][2][3] The most common treatment is surgical resection with or without splenic artery reconstruction, or exclusion with catheter intervention, which may reduce postoperative complications, such as pancreas injury. However, when the aneurysm is associated with an arterial anomaly, the treatment becomes complicated, especially if it is presented during pregnancy. We herein report the case of a patient with a splenic artery aneurysm of the hepatosplenomesenteric trunk that presented during pregnancy. case reportA 32-year-old female was referred to our hospital due to the development of a visceral artery aneurysm during pregnancy. Abdominal ultrasonography (US) revealed an aneurysm of 2.5 × 3.5 cm located behind the pancreas head. She was already five months pregnant. The contrast-enhanced computed tomography (CT) scans at that time demonstrated a small aneurysm behind the pancreas (Fig. 1A). The celiac axis and superior mesenteric artery were not observed separately, thus suggesting the formation of a common channel by these arteries. The 3D-CT presented a common channel of the hepatic, splenic and superior mesenteric arteries. The left gastric artery originated independently from the aorta. Thus, a splenic aneurysm of the hepatosplenomesenteric trunk was diagnosed (Fig. 1B). The wide neck of the aneurysm and its close location to the orifices of the trunk had indicated a high risk of mesenteric obstruction, although catheter embolization was discussed at that time. Thereafter, the patient stopped visiting the hospital because of the asymptomatic nature of the aneurysm. Surgical treatment was recommended because of the increasing risk of rupture either before or during delivery. However, the patient rejected an operation before delivery even with full informed consent. Therefore, the aneurysm was carefully examined every two weeks by abdominal US. Meanwhile, the obstetrician recommended a Caesarian section at 36 weeks to prevent an aneurysm rupture, which may occur due to the stress and effort associated with transvaginal delivery. The pediatrician and vascular surgeons were standing by, and the delivery by Caesarian section We herein report the case of a splenic artery aneurysm with a hepatosplenomesenteric trunk that presented in a pregnant woman. Catheter embolization was not performed due to the wide neck of the aneurysm and its close location to the trunk indicates a high risk of mesenteric trunk thrombosis. We instead performed surgical resection of the aneurysm after successful delivery of the infant by Caesarian section. The splenic artery was reconstructed by side-to-end anastomosis with the common hepatic artery. Splenic Artery Aneurysm of the Hepatosplenomesenteric Trunk

Endovascular coil embolization for an anomalous splenic artery aneurysm with a splenomesenteric trunk

“…Since the first case reported by Ghatan et al 7 in 1967, only 46 cases of an anomalous SAA have been reported. 4 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 A summary of the reported cases is shown in the Table . The mean diameter was 32.5 mm, and 63% of the patients were women.…”

“…Open resection was performed in 25 cases and endovascular treatment in 16 cases (nine coils and seven stent grafts), with no reported complications or deaths. 4 , 5 , 6 , 7 , 8 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 23 , 24 , 25 , 26 , 27 Since the 2000s, endovascular treatment has been applied with increasing frequency. Although the long-term outcomes of stent graft placement at the SA remain unclear, the efficacy of endovascular treatment will be sufficient if the anatomic conditions are appropriate.…”

Splenic Aneurysm Near the Origin of Splenic Artery and Splenic Hamartoma with Stricture of the Celiac Artery Due to Median Arcuate Ligament Compression

“…Mitsuru Tashiro 1) , Tsutomu Fujii 1) , Suguru Yamada 1) , Kojiro Suzuki 2) , Daishi Morimoto 1) , Nobutake Tanaka 1) , Hideki Takami 1) , Masamichi Hayashi 1) , Hiroyuki Sugimoto 1) and Yasuhiro Kodera We report a rare case of splenic aneurysm and splenic hamartoma with stricture of the celiac artery by median arcuate ligament compression. A 35-year-old man was found to have a splenic tumor on a medical examination.…”

A case of a hepatosplenomesenteric trunk combined with a hepatocolic trunk

“…Thus, a hepatosplenomesenteric artery can be present in individuals with otherwise typical vasculature outside the superior aspect of the abdomen. Since the review of the literature by Chen et al [2] hepatosplenomesenteric trunks were reported in a patient undergoing surgery to repair a splenic artery aneurysm [7] and in a patient using computerized tomography. [8] A recently published cadaveric study describes a phrenicogastric trunk arising proximal to the hepatosplenomesenteric trunk, [9] as do we.…”