Features of Surgical Treatment of Patients with Splenic Artery Aneurysms (Case Report and Literature Review)
Despite the insigniϐicant prevalence, aneurysms of the splenicartery take a dominant share among all visceral aneurysms with a predominance of morbidity in women of childbearing age. Taking into account the mostly asymptomatic course and the high risk of mortality due to its rupture, timely diagnosis and correct treatment strategy remain extremely important. Questions regarding the choice of surgical treatment tactics for patients with this pathology remain debatable.
The aim. Demonstration of a clinical case, improvement of diagnosis andsurgical treatment of patients with splenic artery aneurysms.
Clinical case. Female patient G., 32 years old, with complaints of periodic pain in the left hypochondrium, signs of portal hypertension against the background of cavernous transformationof the portal vein, history of recurrent bleeding from the esophageal veins, hypersplenism admitted with a pre-diagnosed aneurysm of the splenic artery of giant dimensions (diameter 8x5 cm). The patient was qualified for open surgery and aneurysm resection with splenectomy and spleen autotransplantation by N. Roth. The postoperative period was complicated by the occurrence of reactive pancreatitis on day 7, which was successfully treated conservatively. In the future, the course was unremarkable. The remote follow-up lasted two years, and no recurrence of the aneurysm was detected. The performed immunogram showed normal results.
Conclusion. The timely diagnosis makes it possible to establish the correct diagnosis, justify the treatment tactics and prevent fatal complications. Open surgical intervention in somecases remains the method of choice in the treatment of this pathology. Autotransplantation of the spleen has shown good long-term results and can be performed in patients of this category for the prevention of immunodeficiency states.
- Akbulut S, Otan E. Management of Giant Splenic Artery Aneurysm: Comprehensive Literature Review. Medicine (Baltimore). 2015;94(27):e1016. https://doi.org/10.1097/MD.0000000000001016
- Appak YC, Baran M, Avci E, Karakoyun M, Ergun O. Mass Image in Stomach: A Case of Splenic Artery Aneurysm. Chin Med J (Engl). 2018;131(13):1630. https://doi.org/10.4103/0366-6999.235119
- Aung YY, Berry C, Jayaram PR, Woon EV. Splenic artery aneurysm in pregnancy: A systematic review. Int J Gynaecol Obstet. Epub 2022 May 22. https://doi.org/10.1002/ijgo.14278
- Berceli SA. Hepatic and Splenic Artery Aneurysms. Semin Vasc Surg. 2005;18(4):196-201. https://doi.org/10.1053/j.semvascsurg.2005.09.005
- Kassem MM, Gonzalez L. Splenic Artery Aneurysm [Internet]. Treasure Island (FL): StatPearls Publishing; 2022; [updated 2022 Jul 18; cited 2022 Aug 23]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430849/
- Trimble WK, Hill JH. Congestive splenomegaly (Banti’s disease) due to portal stenosis without hepatic cirrhosis; aneurysms of the splenic artery. Arch Pathol Lab Med. 1942;34:423.
- Wang A, Gao J. Spontaneous rupture of a splenic artery aneurysm during pregnancy. Asian J Surg. 2022;45(2):739-41. https://doi.org/10.1016/j.asjsur.2021.11.030
- Morton A. Splenic artery aneurysms, portal hypertension and pregnancy. J Hepatol. 2019;70(5):1025-6. https://doi.org/10.1016/j.jhep.2018.12.019
- Hamid HKS, Suliman AEA, Piffaretti G, Spiliopoulos S, Tetreau R, Tozzi M, et al. A systematic review on clinical features and management of true giant splenic artery aneurysms. J Vasc Surg. 2020;71(3):1036-45.e1. https://doi.org/10.1016/j.jvs.2019.09.026
- Panzera F, Inchingolo R, Rizzi M, Biscaglia A, Schievenin MG, Tallarico E, et al. Giant splenic artery aneurysm presenting with massive upper gastrointestinal bleeding: A case report and review of literature. World J Gastroenterol. 2020;26(22):3110-7. https://doi.org/10.3748/wjg.v26.i22.3110
- Abhari P, Abhari S, Jackson A, Moustafa ASZ, Mercer L, Ashraf M. Splenic Artery Aneurysm Case Report. Case Rep Obstet Gynecol. 2019;2019:8347983. https://doi.org/10.1155/2019/8347983
- Lim HJ. A review of management options for splenic artery aneurysms and pseudoaneurysms. Ann Med Surg (Lond). 2020;59:48-52. https://doi.org/10.1016/j.amsu.2020.08.048
- Corvino F, Giurazza F, Ierardi AM, Lucatelli P, Basile A, Corvino A, et al. Splenic Artery Pseudoaneurysms: The Role of ce-CT for Diagnosis and Treatment Planning. Diagnostics (Basel). 2022;12(4):1012. https://doi.org/10.3390/diagnostics12041012
- Therakathu J, Panwala HK, Bhargava S, Eapen A, Keshava SN, David D. Contrast-enhanced Computed Tomography Imaging of Splenic Artery Aneurysms and Pseudoaneurysms: A Single-center Experience. J Clin Imaging Sci. 2018;8:37. https://doi.org/10.4103/jcis.JCIS_21_18
- Pilleul F, Forest J, Beuf O. Angiographie par résonance magnétique dans les anévrismes et pseudoanévrismes des artères splanchniques [Magnetic resonance angiography of splanchnic artery aneurysms and pseudoaneurysms]. J Radiol. 2006;87(2 Pt 1):127-31. French. https://doi.org/10.1016/s0221-0363(06)73983-x
- Saba L, Anzidei M, Lucatelli P, Mallarini G. The multidetector computed tomography angiography (MDCTA) in the diagnosis of splenic artery aneurysm and pseudoaneurysm. Acta Radiol. 2011;52(5):488-98. https://doi.org/10.1258/ar.2011.100283
- Chaer RA, Abularrage CJ, Coleman DM, Eslami MH, Kashyap VS, Rockman C, et al. The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms. J Vasc Surg. 2020;72(1S):3S-39S. https://doi.org/10.1016/j.jvs.2020.01.039
- Zhu C, Zhao J, Yuan D, Huang B, Yang Y, Ma Y, et al. Endovascular and Surgical Management of Intact Splenic Artery Aneurysm. Ann Vasc Surg. 2019;57:75-82. https://doi.org/10.1016/j.avsg.2018.08.088
- Mastracci TM, Cadeddu M, Colopinto RF, Cina C. A minimally invasive approach to the treatment of aberrant splenic artery aneurysms: a report of two cases. J Vasc Surg. 2005;41(6):1053-7. https://doi.org/10.1016/j.jvs.2005.01.056
- Miller SM, Sumpio BJ, Miller MS, Erben Y, Cordova AC, Sumpio BE. Endovascular Repair of Visceral Artery Aneurysms Decreases Length of Hospitalization. J Vasc Endovasc Therapy. 2018;3:21. https://doi.org/10.21767/2573-4482.18.03.21
- Barrionuevo P, Malas MB, Nejim B, Haddad A, Morrow A, Ponce O, et al. A systematic review and meta-analysis of the management of visceral artery aneurysms. J Vasc Surg. 2020;72(1S):40S-45S. https://doi.org/10.1016/j.jvs.2020.05.018
- Obara H, Kentaro M, Inoue M, Kitagawa Y. Current management strategies for visceral artery aneurysms: an overview. Surg Today. 2020;50(1):38-49. https://doi.org/10.1007/s00595-019-01898-3
- Surendran A, Smith M, Houli N, Usatoff V, Spelman D, Choi J. Splenic autotransplantation: a systematic review. ANZ J Surg. 2020;90(4):460-6. https://doi.org/10.1111/ans.15383
- Di Carlo I, Toro A. Splenic Autotransplantation Is Always Valid after Splenectomy. J Invest Surg. 2017;30(6):401-2. https://doi.org/10.1080/08941939.2016.1268656