PDF(Pubmed)
Abstract：
BACKGROUND: Splenic artery aneurysm (SAA) is a focal dilation of the splenic artery with varying etiologies including atherosclerosis, arteritis, or trauma. Giant SAAs with a diameter of 10 cm is rare and can lead to severe complications like rupture and fistulas. Therefore, an accurate and timely diagnosis and treatment are important.
METHODS: A 50-year-old male presented with acute epigastric pain and hemorrhagic shock. Considering his symptoms and examination, ultrasound, multi-slice computed tomography and digital subtraction angiography results, a ruptured giant splenic artery aneurysm complicated with an exceptional gastric and transverse colonic fistula was suspected.
METHODS: Ruptured giant splenic artery aneurysm.
METHODS: Left anterolateral thoracotomy to control the severe aortic bleeding just above the diaphragm, aneurysmectomy, splenectomy, and closing the gastric and transverse colon perforations.
RESULTS: Multi-slice computed tomography demonstrated the presence of splenic artery aneurysm in the distal third measuring (10 × 12 cm) in diameter with a true lumen measuring (7 × 3.5 cm) and a large hematoma extending to the greater and lesser gastric curvature. Intraoperatively, a large pulsating mass was detected occupying the epigastrium and the left hypochondrium with severe adhesions with the stomach and transverse colon.
CONCLUSIONS: Giant SAA with a diameter of 10 cm is rare and is associated with severe complications. Therefore, successful treatment of splenic artery aneurysms involves prompt diagnosis, immediate surgical intervention to control bleeding, and tailored approaches like thoracotomy to control the thoracic aorta for better hemodynamic stabilization, aiming to eliminate the aneurysm and reduce complications effectively.
METHODS: A 50-year-old male presented with acute epigastric pain and hemorrhagic shock. Considering his symptoms and examination, ultrasound, multi-slice computed tomography and digital subtraction angiography results, a ruptured giant splenic artery aneurysm complicated with an exceptional gastric and transverse colonic fistula was suspected.
METHODS: Ruptured giant splenic artery aneurysm.
METHODS: Left anterolateral thoracotomy to control the severe aortic bleeding just above the diaphragm, aneurysmectomy, splenectomy, and closing the gastric and transverse colon perforations.
RESULTS: Multi-slice computed tomography demonstrated the presence of splenic artery aneurysm in the distal third measuring (10 × 12 cm) in diameter with a true lumen measuring (7 × 3.5 cm) and a large hematoma extending to the greater and lesser gastric curvature. Intraoperatively, a large pulsating mass was detected occupying the epigastrium and the left hypochondrium with severe adhesions with the stomach and transverse colon.
CONCLUSIONS: Giant SAA with a diameter of 10 cm is rare and is associated with severe complications. Therefore, successful treatment of splenic artery aneurysms involves prompt diagnosis, immediate surgical intervention to control bleeding, and tailored approaches like thoracotomy to control the thoracic aorta for better hemodynamic stabilization, aiming to eliminate the aneurysm and reduce complications effectively.
摘要：
背景：脾动脉瘤（SAA）是脾动脉的局灶性扩张，具有不同的病因，包括动脉粥样硬化，动脉炎,或者外伤.直径为10厘米的巨型SAA很少见，可导致严重的并发症，如破裂和瘘管。因此,准确及时的诊断和治疗很重要。
方法：一名50岁男性出现急性上腹痛和失血性休克。考虑到他的症状和检查，超声，多层计算机断层扫描和数字减影血管造影结果，怀疑是破裂的巨大脾动脉瘤，并伴有异常的胃和横结肠瘘。
方法：巨大脾动脉瘤破裂。
方法：左胸前外侧切开术控制隔膜上方严重的主动脉出血，动脉瘤切除术,脾切除术,并关闭胃和横结肠穿孔。
结果：多层计算机断层扫描显示远端三分之一直径（10×12cm）的脾动脉瘤存在，真腔测量（7×3.5cm），大血肿延伸到胃曲率的大小。术中,发现一个大的搏动性肿块占据了上腹部和左下软骨，并与胃和横结肠严重粘连。
结论：直径为10cm的巨大SAA很少见，并伴有严重的并发症。因此,脾动脉瘤的成功治疗包括及时诊断，立即手术干预以控制出血，和量身定制的方法，如开胸手术，以控制胸主动脉更好的血流动力学稳定，旨在消除动脉瘤并有效减少并发症。
方法：一名50岁男性出现急性上腹痛和失血性休克。考虑到他的症状和检查，超声，多层计算机断层扫描和数字减影血管造影结果，怀疑是破裂的巨大脾动脉瘤，并伴有异常的胃和横结肠瘘。
方法：巨大脾动脉瘤破裂。
方法：左胸前外侧切开术控制隔膜上方严重的主动脉出血，动脉瘤切除术,脾切除术,并关闭胃和横结肠穿孔。
结果：多层计算机断层扫描显示远端三分之一直径（10×12cm）的脾动脉瘤存在，真腔测量（7×3.5cm），大血肿延伸到胃曲率的大小。术中,发现一个大的搏动性肿块占据了上腹部和左下软骨，并与胃和横结肠严重粘连。
结论：直径为10cm的巨大SAA很少见，并伴有严重的并发症。因此,脾动脉瘤的成功治疗包括及时诊断，立即手术干预以控制出血，和量身定制的方法，如开胸手术，以控制胸主动脉更好的血流动力学稳定，旨在消除动脉瘤并有效减少并发症。
