Ruptured Splenic Artery Aneurysms and the Use of an Adapted Fast Protocol in Reproductive Age Women with Hemodynamic Collapse: Case Series

Nontraumatic symptomatic hypotension in all patients requires prompt diagnosis and appropriate treatment for optimum outcome. The female population specifically has an expanded differential diagnosis that should be considered when these patients present with hemodynamic collapse. While the most common causes of hypotension in pregnant patients are dehydration, ruptured ectopic pregnancy, and placental and uterine abnormalities, less common nonobstetrical etiologies such as hepatic rupture and ruptured abdominal and visceral artery aneurysms should also be considered. Splenic artery aneurysms are associated with high rates of mortality and in cases of pregnancy, maternal and fetal mortality. These high rates can be attributed to the asymptomatic nature of the aneurysm, rapid deterioration after rupture, and frequent misdiagnosis. In patients with hemodynamic collapse, the role of traditional imaging is limited mainly due to the critical condition of the patient. Bedside ultrasound has emerged as a diagnostic imaging resource in patients with undifferentiated hypotension and in patients with traumatic injuries. However, its use has not been studied specifically in the female population. We present two patients with ruptured splenic artery aneurysms, discuss the role of bedside ultrasound in their management, and introduce a new ultrasound protocol for use in reproductive age female patients with hemodynamic collapse.

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Splenic artery aneurysm, case series of seven patients

Journal of Surgical Case Reports ◽

10.1093/jscr/rjab046 ◽

2021 ◽

Vol 2021 (3) ◽

Author(s):

Javad Salimi ◽

Zahra Omrani ◽

Roozbeh Cheraghali

Keyword(s):

Splenic Artery ◽

Endovascular Procedures ◽

Case Series ◽

Artery Aneurysm ◽

Splenic Artery Aneurysm ◽

Visceral Artery ◽

Endovascular Techniques ◽

Hybrid Surgery ◽

First Choice ◽

Visceral Artery Aneurysms

Abstract Splenic artery aneurysms (SAA) account for 46–60% of all visceral artery aneurysms. Small SAAs are usually asymptomatic, but giant aneurysms are more likely to cause symptoms and can result in life-threatening complications. Treatment of a splenic artery aneurysms includes laparotomy, laparoscopy or endovascular techniques. Case presentation: In this article, seven interesting cases of splenic artery aneurysms in different size and parts of artery and various interventions (open, endovascular and hybrid surgery) are discussed. Six of the patients were male. Five of them had giant SAAs (≥5 cm). Two patients underwent hybrid surgery. Coil embolization was carried out for one patient. All seven patients discharged with no procedure-related complications. Endovascular procedures considered as a first choice of treatment for splenic artery aneurysm. Open surgery is reserved mostly for the treatment of complications or if the endovascular techniques fail, lack of availability of endovascular procedures or allergy to contrast medium.

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The Role of Interventional Radiology in the Management of Abdominal Visceral Artery Aneurysms

CardioVascular and Interventional Radiology ◽

10.1007/s00270-011-0201-3 ◽

2011 ◽

Vol 35 (2) ◽

pp. 234-243 ◽

Cited By ~ 73

Author(s):

Anna-Maria Belli ◽

George Markose ◽

Robert Morgan

Keyword(s):

Interventional Radiology ◽

Visceral Artery ◽

Visceral Artery Aneurysms

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Visceral artery aneurysms: evolving interdisciplinary management and future role of the abdominal surgeon

European Journal of Medical Research ◽

10.1186/s40001-019-0374-9 ◽

2019 ◽

Vol 24 (1) ◽

Cited By ~ 4

Author(s):

Vittorio Branchi ◽

Carsten Meyer ◽

Frauke Verrel ◽

Alexander Kania ◽

Edwin Bölke ◽

...

Keyword(s):

Visceral Artery ◽

Interdisciplinary Management ◽

Future Role ◽

Visceral Artery Aneurysms

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Covered stenting and transcatheter embolization of splenic artery aneurysms in diabetic patients: A review of endovascular treatment of visceral artery aneurysms in the current era

Pharmacological Research ◽

10.1016/j.phrs.2018.07.023 ◽

2018 ◽

Vol 135 ◽

pp. 127-135 ◽

Cited By ~ 8

Author(s):

Massimo Venturini ◽

Paolo Marra ◽

Anna Colarieti ◽

Giulia Agostini ◽

Carolina Lanza ◽

...

Keyword(s):

Endovascular Treatment ◽

Splenic Artery ◽

Transcatheter Embolization ◽

Visceral Artery ◽

Diabetic Patients ◽

Visceral Artery Aneurysms

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Splenic artery aneurysm

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912016005005 ◽

2016 ◽

Vol 43 (5) ◽

pp. 398-400 ◽

Cited By ~ 5

Author(s):

RUI ANTÔNIO FERREIRA, TCBC-RJ ◽

MYRIAM CHRISTINA LOPES FERREIRA ◽

DANIEL ANTÔNIO LOPES FERREIRA ◽

ANDRÉ GUSTAVO LOPES FERREIRA ◽

FLÁVIA OLIVEIRA RAMOS

Keyword(s):

Portal Hypertension ◽

Splenic Artery ◽

Artery Aneurysm ◽

Female Gender ◽

Splenic Artery Aneurysm ◽

Visceral Artery ◽

Childbearing Age ◽

Artery Ligation ◽

Visceral Artery Aneurysms ◽

Multiparous Women

ABSTRACT Splenic artery aneurysms - the most common visceral artery aneurysms - are found most often in multiparous women and in patients with portal hypertension. Indications for treatment of splenic artery aneurysm or pseudoaneurysm include specific symptoms, female gender and childbearing age, presence of portal hypertension, planned liver transplantation, a pseudoaneurysm of any size, and an aneurysm with a diameter of more than 2.5cm. Historically, the treatment of splenic artery aneurysm has been surgical ligation of the splenic artery, ligation of the aneurysm, or aneurysmectomy with or without splenectomy, depending on the aneurysm location. There are other percutaneous interventional techniques. The authors present a case of a splenic artery aneurysm in a 51-year-old woman, detected incidentally.

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Avaliação ultrassonográfica no espessamento endometrial: revisão de literatura

Revista de Patologia do Tocantins ◽

10.20873/uft.2446-6492.2017v4n4p60 ◽

2017 ◽

Vol 4 (4) ◽

pp. 60

Author(s):

Débora Filardi Silveira ◽

Carlos Alberto Rodrigues Junior ◽

Fellipe Camargo Ferreira Dias ◽

Camila Filardi Silveira ◽

Caroline Filardi Silveira

Keyword(s):

Transvaginal Ultrasound ◽

Abnormal Uterine Bleeding ◽

Reproductive Age ◽

Female Population ◽

Ultrasound Evaluation ◽

Endometrial Pattern ◽

Uterine Mucosa ◽

Uterine Synechia ◽

Uterine Diseases

Introdução: A avaliação ecográfica do endométrio permite a análise minuciosa da mucosa uterina na prática clínica ginecológica, com o intuito de auxiliar no manejo das patologias endometriais. Neste artigo, fazemos uma revisão narrativa para avaliar o real papel da ecografia pélvica na visualização das doenças endometriais. As alterações uterinas, como pólipos, miomas, sinéquias uterinas, hiperplasia e câncer endometrial são morbidades frequentes na população feminina, tanto nas pacientes em idade reprodutiva como nas que estão na pós-menopausa. Os métodos de avaliação endometrial têm obtido diversos avanços nos tempos atuais, sendo o ultrassom transvaginal o método de escolha para investigação inicial das doenças endometriais, tanto nas pacientes com sangramento genital, quanto nas mulheres assintomáticas principalmente na pós-menopausa. Conclusão: A ecografia é o exame primordial e elementar na investigação de pacientes com sangramento uterino anormal ou sob suspeita de outras doenças que alteram o padrão endometrial, conduzindo o prognóstico do quadro investigado. Palavras-chave: Ultrassonografia, Doenças Uterinas, Endométrio. ABSTRACT Introduction: The ultrasound evaluation of the endometrium allows a detailed analysis of the uterine mucosa in gynecological clinical practice, in order to assist in the management of endometrial pathologies. In this article, we make a narrative review to evaluate the real role of pelvic ultrasound in the visualization of endometrial diseases. Uterine changes such as polyps, fibroids, uterine synechia, hyperplasia, and endometrial cancer are frequent morbidities in the female population, both in postmenopausal and post-reproductive age patients. Methods of endometrial evaluation have achieved several advances in the present times, with transvaginal ultrasound being the method of choice for the initial investigation of endometrial diseases, both in patients with genital bleeding and in asymptomatic women, especially postmenopausal women. Conclusion: Ultrasonography is the primary and elemental examination in the investigation of patients with abnormal uterine bleeding or under suspicion of other diseases that alter the endometrial pattern, leading to the prognosis of the investigated condition. Keywords: Ultrasonography, Uterine Diseases, Endometrium.

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Management of Splenic Artery Aneurysms during Pregnancy

Acta Medica ◽

10.32552/0.actamedica.469 ◽

2020 ◽

Vol 51 (3) ◽

pp. 44-49

Author(s):

Nezih Akkapulu ◽

Derya Karakoç

Keyword(s):

Splenic Artery ◽

Recent Literature ◽

Artery Aneurysm ◽

Splenic Artery Aneurysm ◽

Visceral Artery ◽

Fetal Mortality ◽

Visceral Artery Aneurysm ◽

Diagnostic Features ◽

In Pregnancy

Splenic artery aneurysms are considered rare; however, they are the most common visceral artery aneurysm in reality. The incidence of splenic artery aneurysm (SAA) increases in pregnancy and may result in significant maternal and fetal mortality if that would develop. This review summarizes etiologic, clinical, and diagnostic features and management of splenic artery aneurysms during pregnancy in the light of recent literature.

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Giant splenic artery aneurysm treated surgically with spleen and pancreas preservation

Annals of Saudi Medicine ◽

10.5144/0256-4947.2021.253 ◽

2021 ◽

Vol 41 (4) ◽

pp. 253-256

Author(s):

Igor Atanasijevic ◽

Srdjan Babic ◽

Slobodan Tanaskovic ◽

Predrag Gajin ◽

Nenad Ilijevski

Keyword(s):

Splenic Artery ◽

Artery Aneurysm ◽

Splenic Artery Aneurysm ◽

Visceral Artery ◽

Rare Clinical Entity ◽

Hemodynamic Changes ◽

Visceral Artery Aneurysms ◽

Pancreas Preservation ◽

Aneurysm Development ◽

Changes In Pregnancy

Aneurysms of the splenic artery represent a rare clinical entity, even though they account for 60-70% of all visceral artery aneurysms. Splenic artery aneurysms larger than 5 cm are extremely rare, and they are considered to be giant. Possible causes of splenic artery aneurysm development include: trauma, hormonal and local hemodynamic changes in pregnancy, portal hypertension, arterial degeneration, infection and postsplenectomy occurrence. Surgical treatment of giant splenic artery aneurysms includes procedures that frequently require pancreatectomy and splenectomy. We present a case of a 10.2 cm giant splenic artery aneurysm, firmly adhered to the pancreas, which was treated surgically, with spleen and pancreas preservation. SIMILAR CASES PUBLISHED: Although many cases on treatment of giant splenic artery aneurysm have been published, the majority have described additional visceral resections associated with aneurysmectomy, which is in contrast with our report. Furthermore, aneurysms reaching 10 cm in size were extremely rare.

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Rupture of a splenic artery aneurysm during pregnancy with maternal and foetal death

Medicine Science and the Law ◽

10.1258/rsmmsl.48.4.342 ◽

2008 ◽

Vol 48 (4) ◽

pp. 342-345 ◽

Cited By ~ 8

Author(s):

Matthew J. Lynch ◽

Noel W.F. Woodford

Keyword(s):

Splenic Artery ◽

Clinical Presentation ◽

Strong Association ◽

Artery Aneurysm ◽

Splenic Artery Aneurysm ◽

Visceral Artery ◽

Foetal Death ◽

Third Trimester ◽

Foetal Mortality ◽

Visceral Artery Aneurysms

Aneurysms of the splenic artery are rare although they are the most common of the so-called visceral artery aneurysms. First described by Beaussier in 1770, approximately 400 cases have now been reported in the literature. There is a strong association with pregnancy and since Corson's first description of the death of a mother in the third trimester from rupture of a splenic artery aneurysm, some 25% of reported cases have involved pregnant women. Arterial rupture is an obstetric emergency and associated with maternal and foetal mortality rates approaching 75% and 95% respectively. There are only 14 reported instances where both mother and baby survived. The clinical presentation is protean and in most cases splenic artery aneurysm is identified unexpectedly at angiography, laparotomy or post-mortem examination.

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