Laparoscopic surgery for the treatment of a ruptured aneurysm of the right gastric artery: a case report

Abstract

Laparoscopic surgery for the treatment of a ruptured visceral artery aneurysm is recognized as a challenging procedure. Here, we describe our experience with laparoscopic surgery to treat a ruptured aneurysm of the right gastric artery. A 72-year-old woman was diagnosed with intra-abdominal hemorrhage caused by a ruptured aneurysm of the right gastric artery. Transcatheter arterial embolization failed because the right gastric artery could not be cannulated. Therefore, we performed laparoscopic surgery. Using laparoscopy, we detected that the bleeding from the aneurysm had ceased; thus, the planned procedure was successful. The operative time and intraoperative blood loss were 100 min and 5 mL, respectively. The patient was discharged 7 days after surgery. Laparoscopic surgery after the failure of transcatheter arterial embolization is a suitable and safe procedure for ruptured visceral artery aneurysms, provided the circulatory dynamics are stable as a result of the temporary cessation of bleeding from the ruptured aneurysm.

Single-Incision Laparoscopic Splenectomy for an Unruptured Aneurysm of the Splenic Artery

“…Laparoscopic surgery has become increasingly accepted as a surgical approach for unruptured visceral artery aneurysms in which transcatheter arterial embolization is impossible [4,5]. When the aneurysm of the splenic artery is close to the hilum of the spleen, laparoscopic splenectomy is a suitable and safe procedure [3,4,5,7]. In previous reports [3,4,5,7,8], laparoscopic splenectomies for aneurysms of the splenic artery were performed in 24 patients, including 3 patients with a distal pancreatectomy.…”

“…When the aneurysm of the splenic artery is close to the hilum of the spleen, laparoscopic splenectomy is a suitable and safe procedure [3,4,5,7]. In previous reports [3,4,5,7,8], laparoscopic splenectomies for aneurysms of the splenic artery were performed in 24 patients, including 3 patients with a distal pancreatectomy. SILS for aneurysms of the splenic artery were performed in 3 patients, including our patient; however, 2 other patients had an additional port and/or a cloth tape to hang the hilum of the spleen from an extra-abdominal cavity [8].…”

A rare case of spontaneous rupture of an aneurysm of the right gastric artery

“…With regard to gastric and gastroepiploic artery aneurysms, the left gastric artery (LGA) origin is the site of involvement in a majority of cases. Aneurysms occurring at the origin of the RGA have been reported in very few cases [4] , [10] , [11] , [12] , [13] , [14] , [15] ( Table 1 ). In our patient, we detected an aneurysm at the origin of the RGA using angiography images reconstructed from a CT scan.…”

“…TAE and laparoscopic aneurysmal resection, by virtue of being less invasive are widely accepted treatment options for stable visceral aneurysms [1] , [3] . However, management of ruptured visceral aneurysms might be difficult using these techniques, although some studies have reported successful TAE for cases of ruptured visceral aneurysms [15] , [16] , [17] . TAE is becoming increasingly popular for management of emergency intra-abdominal bleeding, traumatic visceral organ injury, ruptured aneurysms, diverticular or ulcer bleeding among other such conditions.…”

“…We therefore performed an emergency laparotomy with ligation of the RGA and resection of the aneurysm. Toyoda et al, have reported a case of ruptured visceral aneurysm successfully treated via a laparoscopic approach [15] . We recommend that in hemodynamically unstable patients with uncontrolled continuous bleeding, laparoscopic surgery must be avoided because if the surgical field during the laparoscopic procedure is not clear owing to profuse bleeding, an unacceptable delay in establishing hemostasis could be fatal.…”