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.

UNASSIGNED: The Warshaw method as a technique for spleen-preserving distal pancreatectomy (SPDP) carries the risk of splenic infarction following splenic artery ligation. This study introduces a modified Warshaw method, which preserves the splenic artery while sacrificing the splenic vein, and compares its outcomes with the traditional Warshaw method.
UNASSIGNED: According to the bleeding status during vessel dissection, either the Warshaw method (group W) or the modified Warshaw method (group MW) was used. Guided by preoperative imaging, we utilized the planned modified Warshaw method (group PMW) when the splenic vein was embedded in the pancreatic parenchyma.
UNASSIGNED: Group MW demonstrated a lower incidence of splenic infarction and engorged gastric collaterals than group W (6.3% vs. 69.8%, P<0.001; 25.0% vs. 55.8%, P=0.003, respectively). There were no significant differences in perioperative changes of splenic volume between the two groups. Group PMW experienced less estimated blood loss than group W (71.9±59.13 vs. 357.9±447.72 cc, P=0.006).
UNASSIGNED: The planned modified Warshaw method is an efficient and safe technique, resulting in lower estimated blood loss and favorable outcomes concerning splenic infarction and gastric collaterals than the Warshaw method without inducing congestive splenomegaly.

UNASSIGNED: During the routine dissection classes for undergraduate medical students, we encountered a rare anatomical variation concerning the aberrant origin and course of the accessory splenic artery. The splenic artery is one of the direct branches of the coeliac trunk. During its tortuous course, it supplies the pancreas with greater curvature of the stomach and spleen. The accessory splenic artery originating from the main trunk of splenic artery, too, follows the same tortuous course while running through the lesser sac and supplies the posterior part of the spleen via the splenophrenic ligament. The accessory splenic artery is gaining clinical importance during various GI surgeries and some radiological procedures. The unnoticed accessory splenic artery damage may result in tremendous bleeding while performing GI-based surgery or radiological investigation like angiography. In our case report, the accessory splenic artery is an aberrant origin from the initial part of the actual splenic artery. Knowledge regarding the origin, course and termination is of utmost importance to GI surgeons, radiologists, and anatomists.

OBJECTIVE: Aim: To evaluate the effectiveness of PSAE for secondary prevention of VB episodes in patients with chronic liver disease (CLD) and CSPH.
METHODS: Materials and Methods: One hundred twenty patients (from 2008 to 2020) were submitted of PSAE as secondary prevention treatment. The results of the treatment of 27 patients between 2008 and 2012 (first period) were compared with those of 93 patients treated with PSAE since 2013 (second period), as procedure and management protocol were modificated. VB recurrence rate and mortality (related and non-related to bleeding episodes) were defined as study end-points in both groups at 12-months follow-up.
RESULTS: Results: At 12-months follow-up, 11 (40,7 %) and 54 (58,1 %) patients in groups 1 and 2, respectively, were free from VBs (p=0,129). Overall mortality rate was significantly higher in group 1, as compared to group 2: 10 (37,0 %) versus 6 (6,4 %) patients, respectively (p<0,001), - due to higher frequency of fatal VB events (7 (26,0 %) vs. 3 (3,2 %) patients, respectively; p=0,001).
CONCLUSIONS: Conclusions: PSAE is an effective treatment for secondary prevention of VB in patients with CLD and CSPS. The management protocol modification resulted in the decrease in overall mortality rate and mortality related to recurrent VB episodes.

We present a compelling case of an elderly male with a complex medical history who presented with sepsis secondary to a urinary tract infection. During admission, changes in his abdominal exam prompted imaging studies, which revealed a grade IV splenic laceration with a giant splenic artery pseudoaneurysm containing a suspected arteriovenous fistula component. Multidisciplinary discussion was had regarding patient management which resulted in the decision to perform an emergent splenectomy. Learning points from this case underscore the crucial role of interdisciplinary collaboration in the treatment of this pathology. Additionally, we discuss the decision-making process to support surgical intervention in the absence of clear guidelines in this exceedingly rare condition.

Interventions for portal hypertension are continuously evolving and expanding beyond the realm of medical management. When complications such as varices and ascites persist despite conservative interventions, procedures including transjugular intrahepatic portosystemic shunt creation, transvenous obliteration, portal vein recanalization, splenic artery embolization, surgical shunt creation, and devascularization are all potential interventions detailed in this article. Selection of the optimal procedure to address the underlying cause, treat symptoms, and, in some cases, bridge to liver transplantation depends on the specific etiology of portal hypertension and the patient\'s comorbidities.

OBJECTIVE: Nonoperative management (NOM) of blunt splenic injury (BSI) is well accepted in appropriate patients. Splenic artery embolization (SAE) in higher-grade injuries likely plays an important role in increasing the success of NOM. We previously implemented a protocol requiring referral of all BSI grades III-V undergoing NOM for SAE. It is unknown the risk of complications as well as longitudinal outcomes. We aimed to examine the splenic salvage rate and safety profile of the protocol. We hypothesized the splenic salvage rate would be high and complications would be low.
METHODS: A retrospective study was performed at our Level 1 trauma center over a 9-year period. Injury characteristics and outcomes in patients sustaining BSI grades III-V were collected. Outcomes were compared for NOM on protocol (SAE) and off protocol (no angiography or angiography but no embolization). Complications for angiographies were examined.
RESULTS: Between January 2010 and February 2019, 570 patients had grade III-V BSI. NOM was attempted in 359 (63 %) with overall salvage rate of 91 % (328). Of these, 305 were on protocol while 54 were off protocol (41 no angiography and 13 angiography but no SAE). During the study period, for every grade of injury a pattern was seen of a higher salvage rate in the on-protocol group when compared to the off-protocol group (Grade III, 97 %(181/187) vs. 89 %(32/36), Grade IV, 91 %(98/108) vs. 69 %(9/13) and Grade V, 80 %(8/10 vs. 0 %(0/5). The overall salvage rate was 94 %(287) on protocol vs. 76 %(41) off protocol (p < 0.001, Cochran-Mantel-Haenszel test). Complications occurred in only 8 of the 318 who underwent angiography (2 %). These included 5 access complications and 3 abscesses.
CONCLUSIONS: The use of a protocol requiring routine splenic artery embolization for all high-grade spleen injuries slated for non-operative management is safe with a very low complication rate. NOM with splenic angioembolization failure rate is improved as compared to non-SAE patients\' at all higher grades of injury. Thus, SAE for all hemodynamically stable patients of all high-grade types should be considered as a primary form of therapy for such injuries.

Patients presenting with ascites should be properly evaluated to differentiate potential etiologies. Then, based on the evaluation, we can tailor more accurate treatment plans for patients. Cirrhosis is the most common cause, and others include cancer, heart failure, and, in our case, rarely a visceral artery rupture. Rupture of the splenic artery aneurysm can be lethal and should be considered as a possible differential in a patient with no previous history of heart failure, cancer, or cirrhosis. Our patient was identified after an initial misdiagnosis of possible ascites secondary to cirrhosis. However, input from an interventional radiologist led to proper identification and tailored management. Early treatment is crucial to prevent complications, including death.

暂无摘要。

Splenic artery embolization plays an important role in the management of various medical and surgical conditions that are non-traumatic in etiology, in addition to its well-established and widely discussed role in managing splenic trauma. In nontraumatic emergencies of catastrophic bleeding originating from the spleen or splenic artery, splenic artery embolization can be effective in achieving hemostasis as a definitive management, temporary stabilizing measure, or preoperative optimization technique. In addition to emergency clinical conditions, splenic artery embolization can be performed electively as an alternative to splenectomy for managing patients with hypersplenism. Herein, we report 6 cases of splenic artery embolization performed at our center to highlight its various indications. This article aims to demonstrate the role of splenic artery embolization in different clinical scenarios and the considerations behind the techniques employed through illustrative cases.