Splenic Artery Pseudoaneurysm in a Patient with Acute Pancreatitis

Mahdi, Mahmoud; Bharwad, Aastha; Seecheran, Rajeev; Zakhour, Joud; Kayali, Majd; Mahdi, Ahmad

doi:10.17161/kjm.vol16.18696

Cited by 1 publication

(3 citation statements)

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“…Although the splenic artery is most common visceral artery affected by pseudoaneurysms [ 3 , 4 , 19 ], SAPs are rare [ 2 , 4 , 8 , 13 ]. There are less than 200 reported cases in the literature and a study out of a quaternary referral academic health care system found only 10 cases after reviewing 18 years of records [ 24 , 25 ]. When they do arise, they have been shown to present in many ways: abdominal pain, nausea, hematemesis, melena, hematochezia and most concerningly, hemorrhagic shock secondary to rupture [ 3 – 6 , 8 , 12 , 17 , 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…SAPs may be detected on exam as a pulsatile mass in the upper left quadrant or epigastric region with associated left upper quadrant pain [ 3 , 4 , 28 ]. If ruptured, they can bleed into the stomach, duodenum, lesser sac, pancreatic duct (hemosuccus pancreaticus), colon, or directly into the peritoneal cavity leading to the symptoms described above [ 9 , 24 , 25 , 28 , 29 ]. In our case, the patient presented with acute onset diffuse abdominal pain associated with peritonitis, hypovolemia, and signs of impending hemorrhagic shock.…”

Section: Discussionmentioning

confidence: 99%

“…More recently, transcatheter arterial embolization (TAE) has become the standard treatment option for pseudoaneurysms [ 7 , 20 , 26 ] in hemodynamically stable patients [ 4 , 9 , 10 , 12 , 20 ], due to its lower morbidity and mortality and high success rate [ 3 , 4 , 7 , 10 , 13 ]. In unstable patients [ 2 ], those who fail embolization [ 16 ], or those with persistent or re-bleeding after a TAE procedure, surgery is indicated [ 4 , 9 , 12 , 24 ]. As described above, our patient did not undergo TAE for his diagnosed SAP rupture due to patient being relatively unstable and the interventional radiologist’s assessment of low probability of success given the location, extension, and severity of the active bleeding.…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous rupture of a mycotic splenic artery pseudoaneurysm secondary to histoplasmosis: a case report

Mirande,

Souza,

Thibodeaux

et al. 2024

surg case rep

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Background A splenic artery pseudoaneurysm is a rare pathology that occurs mainly secondary to pancreatitis, abdominal trauma, peptic ulcers, pancreatic and gastric cancers, and infections. It is best diagnosed using computed tomography angiography and typically treated using endovascular embolization and, in some cases, open or laparoscopic surgery. In this report, we present a case of a ruptured mycotic splenic artery pseudoaneurysm containing Histoplasma capsulatum, which to our knowledge is the first case to report a mycotic splenic artery pseudoaneurysm of this nature. Case presentation We report a case of a 42-year-old white male with past medical history of Hepatitis C and IV drug abuse who presented to the Emergency Department with a 24-h history of severe diffuse abdominal pain. He was tachycardic and peritonitic on exam. Work-up demonstrated leukocytosis and lactic acidosis. Computed tomography of the abdomen and pelvis with intravenous contrast showed hemoperitoneum and active extravasation of contrast from the splenic artery into the splenic hilum, associated with a surrounding hematoma measuring 5.3 × 5.0 cm, concerning for ruptured splenic artery pseudoaneurysm. The patient was taken emergently for exploratory laparotomy, where a large intraperitoneal hematoma was evacuated. A ruptured splenic artery pseudoaneurysm was identified, isolated, and controlled, followed by completion splenectomy. Final pathology demonstrated a 3.0 × 1.3 × 0.3 cm pseudoaneurysm wall and a 14 × 9.5 × 5.5 cm spleen containing multiple necrotizing granulomata positive for the presence of Histoplasmosis species. The patient recovered appropriately and was discharged on post-operative day five. Conclusions This case demonstrates a successful approach to a ruptured mycotic splenic artery pseudoaneurysm resulting in a positive outcome. It is a unique case as it highlights, to our knowledge, the first report of splenic artery aneurysm secondary to Histoplasma capsulatum infection. This report helps further the understanding of the pathophysiology as well as the natural history of mycotic splenic pseudoaneurysms.

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