Splenic artery aneurysm: pre-rupture diagnosis is life saving

Abstract

DESCRIPTIONA 55-year-old woman presented to the outpatient surgical clinic with a history of recurrent attacks of left upper quadrant pain over the last year. Each bout of pain lasted for less than 24 h and was stabbing in nature. The pain interfered with the patient's breathing and affected her left shoulder; it was associated with nausea and, occasionally, vomiting. The patient had a normal appetite, no weight loss and no change in bowel habits. She had received several courses of analgesics and antispasmodics on an assumption of left renal colic and irritable bowel syndrome. She was otherwise healthy with no relevant medical or surgical history. She neither smokes nor consumes alcohol.During the latest attack, the patient developed severe, persistent, mainly upper abdominal pain that referred to the left shoulder, and required hospital admission in the surgical unit for further assessment. On examination, she was pale and overweight (body mass index=29.4). Her pulse was 100/min, regular and of good volume. Blood pressure was 140/70 mm Hg, temperature 37.2°C and respiratory rate 24 breaths/min. Abdominal examination revealed tenderness, guarding and rigidity over the upper abdomen and mainly on the left upper quadrant. There were no palpable masses or organomegaly.A full blood count showed haemoglobin level of 13.1 g/dL, white cell count 11×10 9 /L, platelets 250×10 9 /L and the erythrocyte sedimentation rate was 10 mm/h. General urine examination and serum amylase level were normal. All other laboratory tests were within the normal range. Chest X-ray in erect position showed normal lung fields and no air under the diaphragm. Ultrasound scan showed an ill-defined cystic mass (low echo-texture) at the splenorenal area suggesting a complex cystic mass related to the tail of the pancreas. Contrast-enhanced CT revealed a well-defined oval lesion (41 mm×60 mm) seen at the splenic hilum massively enhancing postcontrast, suggestive of aneurysmal dilation of splenic artery with very thin wall (figure 1). CT angiography confirmed the diagnosis of aneurysm at the distal end of the splenic artery with no thrombus within, and a dilated tortuous splenic artery (figure 2). We were concerned that this might be a case of splenic artery aneurysm (SAA) with impending rupture, which usually explains the clinical presentation of abdominal pain. Informed consent was taken and urgent surgery performed.Laparotomy using an upper abdominal midline incision was performed. There was a tortuous course of splenic artery that ended with a thrilled, fragile, compressible mass at the hilum of spleen with a very thin wall (impending rupture), as shown in figure 3. Proximal vascular control using an arterial clamp (bulldog) was applied at the upper border of the pancreas for secure mobilisation of the spleen and to avoid catastrophic haemorrhaging. A splenectomy was performed together with excision of aneurysmal sac (figure 4). The patient had an uneventful postoperative course and was discharged on the sixth postoperative day. The patient was...

Prevalence and predictive factors for development of splenic artery aneurysms in cirrhosis

“…But in some cases with SAA, recurrent left upper quadrant pain [10,12,[17][18][19], spontaneous rupture with intraperitoneal hemorrhage [2,4,6,8,19,20], extrahepatic portal hypertension associated with massive splenomegaly [13], nontender pulsatile lump in left upper abdomen [1] and SAA associated with spontaneous splenorenal shunt in noncirrhotic liver [21] have been reported. In our cases with SAA, we did not record any symptoms and signs can be related to SAA.…”

A Rare Case of Splenic Artery Aneurysm With Unusual Combination of Pancytopenia and Massive Splenomegaly in a Tertiary Care Hospital

“…Dr. Muwaffaq Mezeil Telfah's study on the pre-rupture diagnosis of SAAs highlighted that all three blood cell counts (RBCs, WBCs, and platelets) remained normal in their cases. In contrast, the discussed case featured pancytopenia, indicating a notable difference in the presentation [ 12 ].…”

Splenic Artery Aneurysm (SAA) Rupture in Pregnancy: A Case Report of a Rare but Life-Threatening Obstetrical Complication

“…The surgical options for the repair of splenic artery aneurysms vary from open to laparoscopic to embolization. In the pregnant patient with a symptomatic splenic artery aneurysm, the aim is immediate resuscitation via a cesarean laparotomy with splenectomy or splenopancreatectomy and ligation of the splenic artery [28]; one thing to keep in mind is that regardless of the approach, we should attempt to preserve the spleen; however, in some cases such as splenic devascularization, or aneurysmal adhesion to the pancreas, splenectomy, pancreatectomy or both may be necessary [28]. The surgical technique usually depends on the location of the SAA, with 80% located in the distal portion of the splenic artery [28].…”