RUPTURED IDIOPATHIC SPLENIC ARTERY PSEUDOANEURYSM — A CASE REPORT AND LITERATURE REVIEW
Keywords:Splenic Artery (MeSH Term), Aneurysm False (MeSH Term), Endovascular Procedures (MeSH Term)
Introduction: Splenic artery pseudoaneurysms (SAP) represent a rare clinical entity typically caused by sequelae of pancreatitis or abdominal trauma. Unprovoked, spontaneous SAP are exceedingly rare, with only two other case reports in the literature up to date. In this paper we pretend to present a case of a ruptured idiopathic SAP successfully treated endovascularly.
Methods: Relevant medical data were collected from hospital database.
Results: The patient is a 75-year-old male with no past history of pancreatitis, abdominal trauma or abdominal surgery. He was admitted in the emergency department with thoracalgia with interscapular irradiation with few hours of evolution. He referred food intolerance with vomiting for approximately 7 days.
In the diagnostic work-up, a computed tomography angiogram (CTA) was performed and revealed a previously unknown voluminous hiatus hernia and a ruptured 25 mm SAP with active bleeding into a 104x98 mm perigastric collection in the left hypochondrium extending to the thorax, a 34 mm peri-pancreatic and a 35 mm pararenal collection. Urgent treatment was planned in the angiography suite, and after selective catheterization of the splenic artery, pseudoaneurysm origin was identified and embolized both proximally and distally with coils. The end result angiogram was apparently successful. CTA was repeated and revealed complete embolization of the pseudoaneurysm, with no evidence of bleeding. Peri-aneurysmatic
collections remained unchanged in size and splenic infarction was evident in 50% of parenchyma. He was discharged 10 days after the initial procedure.
Conclusions: Endovascular surgery seems a good option for SAP even in rupture, with good short-term results. In this case, it was admitted that it could be a bridge to open surgery with aneurysmectomy and splenectomy. However, given the good clinical recovery post-embolization, no further surgery was considered. Nowadays there is little consensus on follow-up, and long term results are largely unknown.
et al. Clinical features and management of splenic artery pseudoaneurysm:
case series and cumulative review of literature.
J Vasc Surg. 2003;38(5):969–74.
2. Chia C, Pandya GJ, Kamalesh A, Shelat VG. Splenic Artery Pseudoaneurysm
Masquerading as a Pancreatic Cyst-A Diagnostic Challenge.
Int Surg. 2015;100(6):1069–71.
3. Schatz RA, Schabel S, Rockey DC. Idiopathic Splenic Artery Pseudoaneurysm
Rupture as an Uncommon Cause of Hemorrhagic Shock.
J Investig Med High Impact Case Rep. 2015;3(2):2324709615577816.
4. Pasha SF, Gloviczki P, Stanson AW, Kamath PS. Splanchnic artery
aneurysms. Mayo Clin Proc. 2007;82(4):472–9.
5. Betal D, Khangura JS, Swan PJ, Mehmet V. Spontaneous ruptured
splenic artery aneurysm: a case report. Cases J. 2009;2:7150.
6. Szpakowicz J, Szpakowicz P, Urbanik A, Markuszewski L. Splenic
Artery Pseudoaneurysm Rupture into a Pancreatic Pseudocyst with
its Subsequent Perforation as the Cause of a Massive Intra-Abdominal
Bleeding — Case Report. Pol Przegl Chir. 2016;88(6):350–5.
7. O'Brien J, Muscara F, Farghal A, Shaikh I. Haematochezia from
a Splenic Artery Pseudoaneurysm Communicating with Transverse
Colon: A Case Report and Literature Review. Case Rep Vasc Med.
8. Guillon R, Garcier JM, Abergel A, Mofid R, Garcia V, Chahid T, et al.
Management of splenic artery aneurysms and false aneurysms
with endovascular treatment in 12 patients. Cardiovasc Intervent
9. Pitton MB, Dappa E, Jungmann F, Kloeckner R, Schotten S,
Wirth GM, et al. Visceral artery aneurysms: Incidence, management,
and outcome analysis in a tertiary care center over one decade.
Eur Radiol. 2015;25(7):2004–14.
10. Reed NR, Oderich GS, Manunga J, Duncan A, Misra S, de Souza LR, et al.
Feasibility of endovascular repair of splenic artery aneurysms using
stent grafts. Journal of vascular surgery. 2015;62(6):1504–10.
11. Li ES, Mu JX, Ji SM, Li XM, Xu LB, Chai TC, et al. Total splenic artery
embolization for splenic artery aneurysms in patients with normal
spleen. World J Gastroenterol. 2014;20(2):555–60.
12. Ierardi AM, Petrillo M, Bacuzzi A, Floridi C, Dionigi G, Piffaretti G, et al.
Endovascular retreatment of a splenic artery aneurysm refilled
by collateral branches of the left gastric artery: a case report.
J Med Case Rep. 2014;8:436.
13. Yamamoto S, Hirota S, Maeda H, Achiwa S, Arai K, Kobayashi K, et al.
Transcatheter coil embolization of splenic artery aneurysm. Cardiovascular
and interventional radiology. 2008;31(3):527–34.
14. Yamaguchi S, Horie N, Hayashi K, Fukuda S, Morofuji Y, Hiu T, et al.
Point-by-point parent artery/sinus obliteration using detachable,
pushable, 0.035-inch coils. Acta neurochirurgica. 2016;158(11):2089–94.