Spontaneous Splenic Artery Pseudoaneurysm Rupture Causing Hemorrhagic Shock

Montrief, Tim; Parris, Mehruba Anwar; Auerbach, Jonathan; Scott, J.W.; Cabrera, Jorge L.

doi:10.7759/cureus.8286

Cited by 4 publications

(5 citation statements)

References 10 publications

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“…Pseudoaneurysms form because of injury to the vessel wall allowing blood to flow extraluminally which is contained by surrounding tissue [ 15 ]. Injury resulting in splenic artery pseudoaneurysm (SAP) formation are most commonly associated with acute and chronic pancreatitis, as well as abdominal trauma, gastric ulceration, pancreatic and gastric cancers, and infection [ 1 – 5 , 8 , 16 – 18 ]. When secondary to infection, they are termed mycotic pseudoaneurysms.…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous rupture of a mycotic splenic artery pseudoaneurysm secondary to histoplasmosis: a case report

Mirande,

Souza,

Thibodeaux

et al. 2024

surg case rep

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Background A splenic artery pseudoaneurysm is a rare pathology that occurs mainly secondary to pancreatitis, abdominal trauma, peptic ulcers, pancreatic and gastric cancers, and infections. It is best diagnosed using computed tomography angiography and typically treated using endovascular embolization and, in some cases, open or laparoscopic surgery. In this report, we present a case of a ruptured mycotic splenic artery pseudoaneurysm containing Histoplasma capsulatum, which to our knowledge is the first case to report a mycotic splenic artery pseudoaneurysm of this nature. Case presentation We report a case of a 42-year-old white male with past medical history of Hepatitis C and IV drug abuse who presented to the Emergency Department with a 24-h history of severe diffuse abdominal pain. He was tachycardic and peritonitic on exam. Work-up demonstrated leukocytosis and lactic acidosis. Computed tomography of the abdomen and pelvis with intravenous contrast showed hemoperitoneum and active extravasation of contrast from the splenic artery into the splenic hilum, associated with a surrounding hematoma measuring 5.3 × 5.0 cm, concerning for ruptured splenic artery pseudoaneurysm. The patient was taken emergently for exploratory laparotomy, where a large intraperitoneal hematoma was evacuated. A ruptured splenic artery pseudoaneurysm was identified, isolated, and controlled, followed by completion splenectomy. Final pathology demonstrated a 3.0 × 1.3 × 0.3 cm pseudoaneurysm wall and a 14 × 9.5 × 5.5 cm spleen containing multiple necrotizing granulomata positive for the presence of Histoplasmosis species. The patient recovered appropriately and was discharged on post-operative day five. Conclusions This case demonstrates a successful approach to a ruptured mycotic splenic artery pseudoaneurysm resulting in a positive outcome. It is a unique case as it highlights, to our knowledge, the first report of splenic artery aneurysm secondary to Histoplasma capsulatum infection. This report helps further the understanding of the pathophysiology as well as the natural history of mycotic splenic pseudoaneurysms.

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Section: Discussionmentioning

confidence: 99%

“…The risk of rupture of an SAP has been estimated to be near 37%, with a mortality rate of 90% if left untreated [ 5 , 10 , 14 , 20 ]. The hemodynamic status of these patients, location of the SAP, and risk of organ ischemia helps to guide its management.. [ 2 , 3 , 13 , 28 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous rupture of a mycotic splenic artery pseudoaneurysm secondary to histoplasmosis: a case report

Mirande,

Souza,

Thibodeaux

et al. 2024

surg case rep

View full text Add to dashboard Cite

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“…In true aneurysms, the wall is composed of intima, media, and adventitia. In comparison, pseudoaneurysms have a thin wall [6] containing only intima and media, which explains their higher risk of spontaneous rupture and their higher mortality rate [7]. There is no correlation between the size of a pseudoaneurysm and rupture in the literature [3].…”

Section: Discussionmentioning

confidence: 99%

Hemorrhagic Shock Revealing Rupture of Splenic Artery Pseudoaneurysm Three Years After Post-Traumatic Pancreatitis

Aidaoui¹,

Bensaad²,

Habi³

et al. 2021

Cureus

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Splenic artery pseudoaneurysm (SAP) is an uncommon entity but extremely serious, given the high mortality rate if untreated. Only a limited literature reports association with post-traumatic pancreatitis. We report the case of a 30-year-old man, who was brought to the emergency department (ED) for acute confusion. His past medical history includes trauma of right hypochondriac and epigastric regions, three years ago. Three days before his admission to the hospital, he experienced abdominal pain with nausea and vomiting, without transit disorders or fever. When examined, the patient was disoriented, pale with profuse sweating, cold extremities, and a temperature of 36.3°C. Blood pressure was 75/51 mmHg, heart rate was 126 beats per minute, and oxygen saturation was 96% on room air. The abdominal exam detected generalized abdominal sensitivity. A CT angiography of the abdomen revealed hemoperitoneum of medium abundance, with extravasation of the contrast product from the splenic artery. The size of the spleen was normal with a lower polar hypodense area. In addition, a pancreas of normal size, steady outlinings, seat of bilobed cystic formation suggested a pancreatic pseudocyst. This led us to suspect a rupture of a pseudoaneurysm of the splenic artery. A laparotomy was performed and showed an estimated 2 L hemoperitoneum. Active bleeding was noted from an SAP in the mid-portion of the splenic artery, next to the pancreatic pseudocyst. Ligation of the splenic artery and splenectomy was carried out. The patient was discharged home on the 10th post-operative day. Our case highlights an uncommon cause of hemorrhagic shock, but critical to recognize. Indeed, ruptured SAP needs to be promptly detected and managed, to avoid fatal complications if left untreated.

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“…Псевдоаневризмы селезеночной артерии являются редкими и жизнеугрожающими осложнениями острого и хронического панкреатита [10]. При остром панкреатите ферменты протеолиза, секретируемые поджелудочной железой, запускают факторы локального воспаления, вследствие которого развивается окклюзия близлежащих вен, а также возникают эрозии стенки артерий, что, в свою очередь, приводит к образованию псевдоаневризм селезеночной, гастродуоденальной, верхней брыжеечной и других артерий [8].…”

Section: Discussionunclassified

“…Диагностика ЛA у больных ХП на основе клинической симптоматики достаточно затруднительна. В большинстве случаев это случайная находка при обследовании пациента с хроническим панкреатитом [8][9][10]. Поэтому инструментальные методы диагностики являются основными в верификации диагноза [4,6,7].…”

Section: Introductionunclassified

Splenic artery pseudoaneurysm complicated by haemorrhage into pancreatic pseudocyst: a clinical case

Durleshter

Макаренко

Бухтояров

et al. 2021

Kuban. nauсh. med. vestnik

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Background. Splenic artery pseudoaneurysm is a rare complication of acute and chronic pancreatitis caused by an arterial wall lesion with aggressive pancreatic enzymes and followed by arrosive bleeding into pseudocyst lumen and the formation of a dense fibrous capsule prone to growth.Clinical Case Description. Patient M., 61 yo, was emergently admitted to Territorial Clinical Hospital No. 2 with a preliminary diagnosis: Chronic pancreatitis, incomplete remission. Pancreatic pseudocyst. Condition after endoscopic papillosphincterotomy, pancreatic duct stenting. Gastrointestinal haemorrhage. The patient complained of moderate persistent belting upper abdominal and left subcostal pain, nausea, general weakness, black liquid stool over last five days. Pancreonecrosis in history. Pseudocyst formation in two months, endoscopic papillosphincterotomy and pancreatic stenting in hospital, the aforementioned complaints appeared past three months. Moderate anaemia (haemoglobin 73 g/L, erythrocyte count 2.8 x 1012), hyperamylasaemia (amylase 170 U/L), no other pathology in general and biochemic blood panels. The patient was rendered urgent oesophagogastroduodenoscopy for large duodenal papilla, with no evident bleeding detected. Abdominal CT angiography revealed a haemorrhagic mass connected with splenic artery lumen in the projection of pancreatic tail. The patient was transferred to an interventional radiology room for coil embolisation of splenic artery. The postoperative period was benign, and the patient discharged on day 3 after surgery for outpatient surgical patronage. Definite clinical diagnosis: Chronic pancreatitis, incomplete remission. Splenic artery pseudoaneurysm with haemorrhage into pancreatic pseudocyst. Condition after endoscopic papillosphincterotomy, pancreatic duct stenting.Conclusion. Splenic artery pseudoaneurysm with haemorrhage into pancreatic pseudocyst is reluctant to early diagnosis due to a lacking definite clinical picture and tractable only at an interdisciplinary institution disposing with a rich diagnostic toolkit and sufficiently qualified medical personnel. Endovascular treatment is overall most effective and enables a reliable aneurysm isolation from the splenic artery basin.

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Spontaneous Splenic Artery Pseudoaneurysm Rupture Causing Hemorrhagic Shock

Cited by 4 publications

References 10 publications

Spontaneous rupture of a mycotic splenic artery pseudoaneurysm secondary to histoplasmosis: a case report

Spontaneous rupture of a mycotic splenic artery pseudoaneurysm secondary to histoplasmosis: a case report

Hemorrhagic Shock Revealing Rupture of Splenic Artery Pseudoaneurysm Three Years After Post-Traumatic Pancreatitis

Splenic artery pseudoaneurysm complicated by haemorrhage into pancreatic pseudocyst: a clinical case

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