Laparoscopic ligation of proximal splenic artery aneurysm with splenic function preservation

Abstract

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.

Aneurysm resection and vascular reconstruction for true aneurysm at the initial segment of splenic artery

“…With some aneurysms which are of huge size, or located at special sites, or structurally aberrant, the endovascular intervention is not feasible. Obuchi et al [12] and Wei et al [2] believed that, for aneurysms greater than 5 cm, or with a wide neck, or in the vicinity of hepatic artery or celiac trunk, interventional therapy is very difficult and tend to cause complications. In these cases, traditional open surgery, consisting of aneurysmectomy and vascular reconstruction, are the treatment of choice because they relatively safe and reliable in these cases [4,[18][19][20] .…”

“…Despite several studies reporting laparoscopic aneurysmectomy at the distal segment of the splenic artery and the proximal segment of the splenic artery, so far there was not report on laparoscopic aneurysmectomy at the initial part of the splenic artery. Wei et al [2] reported only 1 case of laparoscopic aneurysmectomy at the proximal part of the splenic artery over the past decade.…”

“…The aneurismal rupture is the biggest threat to the patients with aneurysm at the initial portion of splenic artery. The aneurismal rupture tends to manifest as acute abdominal pain, which sometimes radiates to the back or shoulder, quick drop of blood pressure and the fast pulse rate, rapidly-progressive hemorrhagic shock or even sudden death [2,14] . Khoshnevis et al [14] reported an incidence of aneurysm rupture of 25% and a mortality rate of 25%-70%.…”

“…With the improvement of endoscopic techniques, the resection of the splenic artery aneurysm under laparoscopy have been reported [2,[23][24][25][26] . But it has not been extensively applied because of restraints in techniques, equipment and tumor topography.…”

“…The splenic artery aneurysm is the most common form of visceral artery aneurysms, accounting for 40%-60% of all cases of visceral artery aneurysms. The aneurysms are mostly located in the middle and distal segments of splenic artery or near splenic hilum [1][2][3][4] , while the true aneurysm at the initial segment of splenic artery is very different and rare [1-3, 5, 6] . Since few clinical data on the disease are available, etiological and epidemiological studies concerning the aneurysms are scanty.…”