Here, we discuss a 78-year-old woman with symptoms of shortness of breath and intermittent productive cough, which worsened over time. She had a history of Factor V Leiden and unprovoked pulmonary embolism (PE) and wa...Here, we discuss a 78-year-old woman with symptoms of shortness of breath and intermittent productive cough, which worsened over time. She had a history of Factor V Leiden and unprovoked pulmonary embolism (PE) and was on lifelong warfarin. The patient was found to have a widened mediastinum and a small left-sided pleural effusion on chest X-ray, leading to CT aortogram to assess for aortic pathology. While in the CT scanner, she experienced an acute deterioration and went into shock. The initial diagnosis was anaphylactic reaction to the contrast agent, but the CT images revealed an active bleeding in the left upper quadrant, possibly of splenic origin. The patient was stabilized with aggressive resuscitation measures and transferred to a referral hospital for urgent surgery. The surgery revealed a ruptured splenic artery aneurysm (SAA), and the patient was taken to the intensive care unit (ICU) for further management. However, she developed a large infarct in the left occipital lobe and passed away after six days. The case highlights the significance of recognizing the symptoms and signs of SAA and then taking a multidisciplinary approach in managing SAA patients, particularly those with hypercoagulability (Graphic 1).展开更多
Splenic arteriovenous fistula （SAVF） accounts for an unusual but well-documented treatable cause of portal hypertension. A case of a 50-year-old multiparous female who developed suddenly portal hypertension due to S...Splenic arteriovenous fistula （SAVF） accounts for an unusual but well-documented treatable cause of portal hypertension. A case of a 50-year-old multiparous female who developed suddenly portal hypertension due to SAVF formation is presented. The patient suffered from repeated episodes of haematemesis and melaena during the past twelve days and thus was emergently admitted to hospital for management. Clinical and laboratory investigations established the diagnosis of portal hypertension in the absence of liver parenchymal disease. Endoscopy revealed multiple esophageal bleeding varices. Abdominal computed tomography （CT） and transfemoral celiac arteriography documented the presence of a tortuous and aneurysmatic splenic artery and premature filling of an enlarged splenic vein, findings highly suggestive of an SAVF. The aforementioned vascular abnormality was successfully treated with percutaneous transcatheter embolization. Neither recurrence nor other complications were observed.展开更多
BACKGROUND:Giant splenic artery aneurysm (GSAA) is a rare but clinically relevant disease. Its importance lies in potential rupture and hemorrhage. Early diagnosis and treatment before rupture of GSAA are crucial to G...BACKGROUND:Giant splenic artery aneurysm (GSAA) is a rare but clinically relevant disease. Its importance lies in potential rupture and hemorrhage. Early diagnosis and treatment before rupture of GSAA are crucial to GSAA pa- tients especially to GSAA patients with portal hypertension (PHT). METHODS: Four patients of GSAA with PHT treated at our hospital from December 1999 to September 2001 were retrospectively reviewed. RESULTS: GSAA was found in all patients with digital sub- stracted angiography ( DSA) and/or magnetic resonance angiography (MRA) before operation. Resection of GSAA and treatment of PHT were carried out successfully with no perioperative mortality. CONCLUSIONS: Patients with GSAA are apt to have PHT or segmental PHT because of suppression of the splenic vein or formation of aneurysm-portal vein fistula. Opera- tion should be focused on GSAA, and PHT complica- tions.展开更多
Splenic artery aneurysm is one of the most common visceral aneurysms,and patients with this type of aneurysm often present without symptoms.However,when rupture occurs,it can be a catastrophic event.Although most of t...Splenic artery aneurysm is one of the most common visceral aneurysms,and patients with this type of aneurysm often present without symptoms.However,when rupture occurs,it can be a catastrophic event.Although most of these aneurysms can be treated with percutaneous embolization,some located in uncommon parts of the splenic artery may make this approach impossible.We present a patient with an aneurysm in the proximal splenic artery,close to the celiac trunk,which was treated by laparoscopic ligation only,without resection of the aneurysm,and with long-term preservation of splenic function.展开更多
BACKGROUND: Splenic artery aneurysms although rare are clinically significant in view of their propensity for spontaneous rupture and life-threatening bleeding. While portal hypertension is an important etiological fa...BACKGROUND: Splenic artery aneurysms although rare are clinically significant in view of their propensity for spontaneous rupture and life-threatening bleeding. While portal hypertension is an important etiological factor, the majority of reported cases are secondary to cirrhosis of the liver. We report three cases of splenic artery aneurysms associated with extrahepatic portal vein obstruction and discuss their management. METHODS: The records of three patients of splenic artery aneurysm associated with extrahepatic portal vein obstruction managed from 2003 to 2010 were reviewed retrospectively. The clinical presentation, surgical treatment and outcome were analyzed. RESULTS: The aneurysm was >3 cm in all patients. The clinical symptoms were secondary to extrahepatic portal vein obstruction (hematemesis in two, portal biliopathy in two) while the aneurysm was asymptomatic. Doppler ultrasound demonstrated aneurysms in all patients. A proximal splenorenal shunt was performed in two patients with excision of the aneurysm in one patient and ligation of the aneurysm in another one. The third patient had the splenic vein replaced by collaterals and hence underwent splenectomy with aneurysmectomy. All patients had an uneventful post-operative course. CONCLUSIONS: Splenic artery aneurysms are associated with extrahepatic portal vein obstruction. Surgery is the mainstay of treatment. Although technically difficult, it can be safely performed in an experienced center with minimal morbidity and good outcome.展开更多
BACKGROUND Splenic artery aneurysm(SAA)and pseudoaneurysm are rare vessel’s lesions.Pseudoaneurysm is often symptomatic and secondary to pancreatitis or trauma.True SAA is the most common aneurysm of visceral vessels...BACKGROUND Splenic artery aneurysm(SAA)and pseudoaneurysm are rare vessel’s lesions.Pseudoaneurysm is often symptomatic and secondary to pancreatitis or trauma.True SAA is the most common aneurysm of visceral vessels.In contrast to pseudoaneurysm,SAA is usually asymptomatic until the rupture,with high mortality rate.The clinical onset of SSA’s rupture is a massive life-threatening bleeding with hemodynamic instability,usually into the free peritoneal space and more rarely into the gastrointestinal tract.CASE SUMMARY We describe the case of a 35-year-old male patient,with negative past medical history,who presented to the emergency department for massive upper gastrointestinal bleeding,severe anemia and hypotension.An esophagogastroduodenoscopy performed in emergency showed a gastric bulging in the greater curvature/posterior wall with a small erosion on its surface,with a visible vessel,but no active bleeding.Endoscopic injection therapy with cyanoacrylate glue was performed.Urgent contrast-enhanced computed tomography was carried out due to the clinical scenario and the unclear endoscopic aspect:The radiological examination showed a giant SAA which was adherent to posterior stomach wall,and some smaller aneurysms of the left gastric and ileocolic artery.Because of the high risk of a two-stage rupture of the giant SAA with dramatic outcome,the patient underwent immediate open surgery with aneurysmectomy,splenectomy and distal pancreatectomy with a good postoperative outcome.CONCLUSION The management of a ruptured giant SAA into the stomach can be successful with surgical approach.展开更多
Segmental arterial mediolysis(SAM) is characterized by intra-abdominal, retroperitoneal bleeding or bowel ischemia, and the etiology is unknown. A 44-year-old man complaining of abdominal pain was admitted to our hosp...Segmental arterial mediolysis(SAM) is characterized by intra-abdominal, retroperitoneal bleeding or bowel ischemia, and the etiology is unknown. A 44-year-old man complaining of abdominal pain was admitted to our hospital. He had been admitted for a left renal infarction three days earlier and had a past medical history of cerebral aneurysm with spontaneous remission. The ruptured site of the splenic arterial aneurysm was clear via a celiac angiography, and we treated it using trans-arterial embolization. Unfortunately, the aneurysm reruptured after two weeks, and we successfully treated it with distal pancreatomy and splenectomy. We recommended a close follow-up and prompt radiological or surgical intervention because SAM can enlarge rapidly and rupture.展开更多
BACKGROUND The rupture of a splenic artery aneurysm(SAA)in pregnancy is an uncommon condition.However,it is associated with high mortality rates in pregnant women and fetuses even after surgical treatment.Though the e...BACKGROUND The rupture of a splenic artery aneurysm(SAA)in pregnancy is an uncommon condition.However,it is associated with high mortality rates in pregnant women and fetuses even after surgical treatment.Though the endovascular treatment of SAAs is currently preferred as it can improve the outcomes even in emergent cases,the endovascular treatment of a ruptured SAA during pregnancy has not been reported until date.CASE SUMMARY We report a case of a 33-year-old woman with the sudden onset of epigastric pain due to a ruptured SAA at the mid-portion of the splenic artery at 18 wk of pregnancy.After emergent initial resuscitation,the patient was diagnosed with a ruptured SAA through digital angiography.Immediately upon diagnosis,she underwent emergent endovascular embolization of the splenic artery for the rupture on the spot.Next,surgery was performed to remove the hematoma under stable conditions.Although the fetus was found to be dead during resuscitation,the woman recovered without complications and was discharged 15 d postoperatively.CONCLUSION Endovascular treatment might be a valuable alternative to surgery/lead to safer surgery for selected pregnant patients with ruptured SAAs.展开更多
We are reporting the rare case of splenic artery aneurysm of 4 cm of diameter presenting as a sub mucosal lesion on gastro-duodenal endoscopy. This aneurysm was treated by endovascular coil embolization and stent graf...We are reporting the rare case of splenic artery aneurysm of 4 cm of diameter presenting as a sub mucosal lesion on gastro-duodenal endoscopy. This aneurysm was treated by endovascular coil embolization and stent graft implantation. The procedure was uneventful. On day 1, the patient presented an acute severe epigastric pain and cardiovascular arrest. Abdominal computed tomography scan showed an active leak of the intravenous contrast dye in the peritoneum from the splenic aneurysm. We performed an emergent resection of the aneurysm, and peritoneal lavage. Postoperatively, hemorrhagic choc was refractory to large volumes replacement, and intravenous vaso-active drugs. On day 2, he presented massive hematochezia. We performed a total colectomy with splenectomy and cholecystectomy for ischemic colitis, with spleen and gallbladder infarction. Despite vaso-active drugs and aggressive treatment with Factor VIIa, the patient died after uncontrolled disseminated intravascular coagulation.展开更多
BACKGROUND Splenic artery aneurysm(SAA)is a rare vascular lesion conventionally treated by resection or interventional therapy.The surgical procedure usually involves splenectomy,and interventional therapy may cause p...BACKGROUND Splenic artery aneurysm(SAA)is a rare vascular lesion conventionally treated by resection or interventional therapy.The surgical procedure usually involves splenectomy,and interventional therapy may cause post-embolization syndromes.Preservation of the spleen and its function is rarely reported during the management of SAA.CASE SUMMARY We report a patient with an asymptomatic SAA(3.5 cm in diameter),which was en-bloc resected laparoscopically using indocyanine green(ICG)fluorescence imaging to preserve the spleen and its function.CONCLUSION ICG fluorescence imaging for spleen preservation in laparoscopic SAA resection is safe and may be beneficial in avoiding splenectomy and maintaining splenic function.展开更多
Splenic artery aneurysm, without obvious symptoms, is a direct threat to the patient＇s life, once it ruptures as hemorrhagic shock.Imaging examinations have been the main diagnostic methods of splenic artery aneurysm...Splenic artery aneurysm, without obvious symptoms, is a direct threat to the patient＇s life, once it ruptures as hemorrhagic shock.Imaging examinations have been the main diagnostic methods of splenic artery aneurysm, including ultrasound, computed tomography （CT）, magnetic resonance imaging, and digital subtraction angiography （DSA）.Although various inspective methods have their own advantages and disadvantages, abdominal CT examination is the most comprehensively applied method in clinical settings.The representative images of splenic artery aneurysm from a relatively large number of patients examined by CT are presented in this study.展开更多
文摘Here, we discuss a 78-year-old woman with symptoms of shortness of breath and intermittent productive cough, which worsened over time. She had a history of Factor V Leiden and unprovoked pulmonary embolism (PE) and was on lifelong warfarin. The patient was found to have a widened mediastinum and a small left-sided pleural effusion on chest X-ray, leading to CT aortogram to assess for aortic pathology. While in the CT scanner, she experienced an acute deterioration and went into shock. The initial diagnosis was anaphylactic reaction to the contrast agent, but the CT images revealed an active bleeding in the left upper quadrant, possibly of splenic origin. The patient was stabilized with aggressive resuscitation measures and transferred to a referral hospital for urgent surgery. The surgery revealed a ruptured splenic artery aneurysm (SAA), and the patient was taken to the intensive care unit (ICU) for further management. However, she developed a large infarct in the left occipital lobe and passed away after six days. The case highlights the significance of recognizing the symptoms and signs of SAA and then taking a multidisciplinary approach in managing SAA patients, particularly those with hypercoagulability (Graphic 1).
文摘Splenic arteriovenous fistula （SAVF） accounts for an unusual but well-documented treatable cause of portal hypertension. A case of a 50-year-old multiparous female who developed suddenly portal hypertension due to SAVF formation is presented. The patient suffered from repeated episodes of haematemesis and melaena during the past twelve days and thus was emergently admitted to hospital for management. Clinical and laboratory investigations established the diagnosis of portal hypertension in the absence of liver parenchymal disease. Endoscopy revealed multiple esophageal bleeding varices. Abdominal computed tomography （CT） and transfemoral celiac arteriography documented the presence of a tortuous and aneurysmatic splenic artery and premature filling of an enlarged splenic vein, findings highly suggestive of an SAVF. The aforementioned vascular abnormality was successfully treated with percutaneous transcatheter embolization. Neither recurrence nor other complications were observed.
文摘BACKGROUND:Giant splenic artery aneurysm (GSAA) is a rare but clinically relevant disease. Its importance lies in potential rupture and hemorrhage. Early diagnosis and treatment before rupture of GSAA are crucial to GSAA pa- tients especially to GSAA patients with portal hypertension (PHT). METHODS: Four patients of GSAA with PHT treated at our hospital from December 1999 to September 2001 were retrospectively reviewed. RESULTS: GSAA was found in all patients with digital sub- stracted angiography ( DSA) and/or magnetic resonance angiography (MRA) before operation. Resection of GSAA and treatment of PHT were carried out successfully with no perioperative mortality. CONCLUSIONS: Patients with GSAA are apt to have PHT or segmental PHT because of suppression of the splenic vein or formation of aneurysm-portal vein fistula. Opera- tion should be focused on GSAA, and PHT complica- tions.
基金Supported by Key Disciplines of Medicine,Zhejiang Province,China,No.11-CX21
文摘Splenic artery aneurysm is one of the most common visceral aneurysms,and patients with this type of aneurysm often present without symptoms.However,when rupture occurs,it can be a catastrophic event.Although most of these aneurysms can be treated with percutaneous embolization,some located in uncommon parts of the splenic artery may make this approach impossible.We present a patient with an aneurysm in the proximal splenic artery,close to the celiac trunk,which was treated by laparoscopic ligation only,without resection of the aneurysm,and with long-term preservation of splenic function.
文摘BACKGROUND: Splenic artery aneurysms although rare are clinically significant in view of their propensity for spontaneous rupture and life-threatening bleeding. While portal hypertension is an important etiological factor, the majority of reported cases are secondary to cirrhosis of the liver. We report three cases of splenic artery aneurysms associated with extrahepatic portal vein obstruction and discuss their management. METHODS: The records of three patients of splenic artery aneurysm associated with extrahepatic portal vein obstruction managed from 2003 to 2010 were reviewed retrospectively. The clinical presentation, surgical treatment and outcome were analyzed. RESULTS: The aneurysm was >3 cm in all patients. The clinical symptoms were secondary to extrahepatic portal vein obstruction (hematemesis in two, portal biliopathy in two) while the aneurysm was asymptomatic. Doppler ultrasound demonstrated aneurysms in all patients. A proximal splenorenal shunt was performed in two patients with excision of the aneurysm in one patient and ligation of the aneurysm in another one. The third patient had the splenic vein replaced by collaterals and hence underwent splenectomy with aneurysmectomy. All patients had an uneventful post-operative course. CONCLUSIONS: Splenic artery aneurysms are associated with extrahepatic portal vein obstruction. Surgery is the mainstay of treatment. Although technically difficult, it can be safely performed in an experienced center with minimal morbidity and good outcome.
文摘BACKGROUND Splenic artery aneurysm(SAA)and pseudoaneurysm are rare vessel’s lesions.Pseudoaneurysm is often symptomatic and secondary to pancreatitis or trauma.True SAA is the most common aneurysm of visceral vessels.In contrast to pseudoaneurysm,SAA is usually asymptomatic until the rupture,with high mortality rate.The clinical onset of SSA’s rupture is a massive life-threatening bleeding with hemodynamic instability,usually into the free peritoneal space and more rarely into the gastrointestinal tract.CASE SUMMARY We describe the case of a 35-year-old male patient,with negative past medical history,who presented to the emergency department for massive upper gastrointestinal bleeding,severe anemia and hypotension.An esophagogastroduodenoscopy performed in emergency showed a gastric bulging in the greater curvature/posterior wall with a small erosion on its surface,with a visible vessel,but no active bleeding.Endoscopic injection therapy with cyanoacrylate glue was performed.Urgent contrast-enhanced computed tomography was carried out due to the clinical scenario and the unclear endoscopic aspect:The radiological examination showed a giant SAA which was adherent to posterior stomach wall,and some smaller aneurysms of the left gastric and ileocolic artery.Because of the high risk of a two-stage rupture of the giant SAA with dramatic outcome,the patient underwent immediate open surgery with aneurysmectomy,splenectomy and distal pancreatectomy with a good postoperative outcome.CONCLUSION The management of a ruptured giant SAA into the stomach can be successful with surgical approach.
基金Supported by The Department of Surgery,Kishiwada Tokushukai Hospital,Osaka,Japan
文摘Segmental arterial mediolysis(SAM) is characterized by intra-abdominal, retroperitoneal bleeding or bowel ischemia, and the etiology is unknown. A 44-year-old man complaining of abdominal pain was admitted to our hospital. He had been admitted for a left renal infarction three days earlier and had a past medical history of cerebral aneurysm with spontaneous remission. The ruptured site of the splenic arterial aneurysm was clear via a celiac angiography, and we treated it using trans-arterial embolization. Unfortunately, the aneurysm reruptured after two weeks, and we successfully treated it with distal pancreatomy and splenectomy. We recommended a close follow-up and prompt radiological or surgical intervention because SAM can enlarge rapidly and rupture.
文摘BACKGROUND The rupture of a splenic artery aneurysm(SAA)in pregnancy is an uncommon condition.However,it is associated with high mortality rates in pregnant women and fetuses even after surgical treatment.Though the endovascular treatment of SAAs is currently preferred as it can improve the outcomes even in emergent cases,the endovascular treatment of a ruptured SAA during pregnancy has not been reported until date.CASE SUMMARY We report a case of a 33-year-old woman with the sudden onset of epigastric pain due to a ruptured SAA at the mid-portion of the splenic artery at 18 wk of pregnancy.After emergent initial resuscitation,the patient was diagnosed with a ruptured SAA through digital angiography.Immediately upon diagnosis,she underwent emergent endovascular embolization of the splenic artery for the rupture on the spot.Next,surgery was performed to remove the hematoma under stable conditions.Although the fetus was found to be dead during resuscitation,the woman recovered without complications and was discharged 15 d postoperatively.CONCLUSION Endovascular treatment might be a valuable alternative to surgery/lead to safer surgery for selected pregnant patients with ruptured SAAs.
文摘We are reporting the rare case of splenic artery aneurysm of 4 cm of diameter presenting as a sub mucosal lesion on gastro-duodenal endoscopy. This aneurysm was treated by endovascular coil embolization and stent graft implantation. The procedure was uneventful. On day 1, the patient presented an acute severe epigastric pain and cardiovascular arrest. Abdominal computed tomography scan showed an active leak of the intravenous contrast dye in the peritoneum from the splenic aneurysm. We performed an emergent resection of the aneurysm, and peritoneal lavage. Postoperatively, hemorrhagic choc was refractory to large volumes replacement, and intravenous vaso-active drugs. On day 2, he presented massive hematochezia. We performed a total colectomy with splenectomy and cholecystectomy for ischemic colitis, with spleen and gallbladder infarction. Despite vaso-active drugs and aggressive treatment with Factor VIIa, the patient died after uncontrolled disseminated intravascular coagulation.
基金Zhejiang Medical and Health Science and Technology Plan,No. 2022RC096Basic Public Welfare Research Project of Zhejiang Province of China,No. LGF20H030011
文摘BACKGROUND Splenic artery aneurysm(SAA)is a rare vascular lesion conventionally treated by resection or interventional therapy.The surgical procedure usually involves splenectomy,and interventional therapy may cause post-embolization syndromes.Preservation of the spleen and its function is rarely reported during the management of SAA.CASE SUMMARY We report a patient with an asymptomatic SAA(3.5 cm in diameter),which was en-bloc resected laparoscopically using indocyanine green(ICG)fluorescence imaging to preserve the spleen and its function.CONCLUSION ICG fluorescence imaging for spleen preservation in laparoscopic SAA resection is safe and may be beneficial in avoiding splenectomy and maintaining splenic function.
文摘Splenic artery aneurysm, without obvious symptoms, is a direct threat to the patient＇s life, once it ruptures as hemorrhagic shock.Imaging examinations have been the main diagnostic methods of splenic artery aneurysm, including ultrasound, computed tomography （CT）, magnetic resonance imaging, and digital subtraction angiography （DSA）.Although various inspective methods have their own advantages and disadvantages, abdominal CT examination is the most comprehensively applied method in clinical settings.The representative images of splenic artery aneurysm from a relatively large number of patients examined by CT are presented in this study.
