doiSerbia

Splenic artery aneurysms: Two cases of varied etiology, clinical presentation and treatment outcome

Pejkić Siniša (Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade + School of Medicine, Belgrade)
Tomić Ivan (Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade + School of Medicine, Belgrade)
Opačić Dragan (Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade)
Pejinović Luka (Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade)
Grubor Nikica (School of Medicine, Belgrade + Clinical Center of Serbia, Clinic for Digestive Surgery, Belgrade)
Činara Ilijas (Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade + School of Medicine, Belgrade)
Davidović Lazar (Clinical Center of Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade + School of Medicine, Belgrade)

Introduction. Splenic artery aneurysms are potentially lethal lesions. We report two illustrative cases and discuss etiology, diagnosis and treatment of these aneurysms. Outline of Cases. Both patients, age 31 and 80 years, were biparous women. The younger woman, otherwise healthy, was referred from a local hospital 3 weeks after she underwent a left subcostal laparotomy and exploration for symptomatic abdominal mass diagnosed by CT. Angiography established the diagnosis of a large, non-ruptured splenic artery aneurysm. Elective aneurysmectomy with splenectomy was performed using the approach through the upper median laparotomy and bursa omentalis. Postoperative course was uneventful. Histopathology demonstrated cystic medial necrosis with chronic dissection. The other patient, elderly woman, presented urgently with acute abdominal pain and syncope and was diagnosed by computed tomography with a huge, ruptured splenic artery aneurysm. She underwent immediate aneurysmectomy with splenectomy using the same, above-mentioned approach. External pancreatic fistula and pancreatic pseudocyst complicated the postoperative course, requiring open pseudocyst drainage and cystojejunostomy. After a protracted hospitalization patient eventually recovered. The pathological diagnosis was atherosclerotic aneurysm. Conclusion. Splenic artery aneurysms are infrequent lesions, with varied etiology and clinical presentation. Timely diagnosis and adequate treatment prevent life-threatening rupture and lessen the risk of operative morbidity and mortality.

Keywords: splenic artery aneurysm, aneurysmectomy, splenectomy, pancreatic pseudocyst

Projekat Ministarstva nauke Republike Srbije, br. 175008