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.
S2347 Spontaneous Ruptured Splenic Artery Aneurysm Presenting as an Acute Abdominal Mass
