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Ruptured aneurysm of the splenic artery: a rare cause of abdominal pain after blunt trauma.

Khoshnevis J, Lotfollahzadeh S, Sobhiyeh MR, Najd Sepas H, Abbas Nejad M, Rahbari A, Behnaz N, Mahdi Z - Trauma Mon (2013)

Bottom Line: Herein we present a young patient with abdominal pain after blunt abdominal trauma due to rupture of an SAA.A 27-year-old male, without a remarkable medical history, who suffered from abdominal pain for 2 days after falling was admitted to the emergency department with hypovolemic shock.Upon performing emergency laparotomy a ruptured splenic artery aneurysm was found.

View Article: PubMed Central - PubMed

Affiliation: Department of Vascular Surgery, Shahid Beheshti University of Medical Sciences and Health Services, Shohadaye Tajrish Hospital, Tehran, IR Iran.

ABSTRACT

Introduction: Splenic artery aneurysms (SAAs) are rare (0.2-10.4%); however, they are the most common form of visceral artery aneurysms. Splenic artery aneurysms are important to identify, because up to 25% of the cases are complicated by rupture. Post- rupture mortality rate is 25% -70% based on the underlying cause. Herein we present a young patient with abdominal pain after blunt abdominal trauma due to rupture of an SAA.

Case presentation: A 27-year-old male, without a remarkable medical history, who suffered from abdominal pain for 2 days after falling was admitted to the emergency department with hypovolemic shock. Upon performing emergency laparotomy a ruptured splenic artery aneurysm was found.

Conclusions: It is important to consider rupture of a splenic artery aneurysm in patients with abdominal pain and hypovolemic shock.

No MeSH data available.


Related in: MedlinePlus

Rupture of Splenic Artery Aneurysm Which Was Located Distally
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fig3464: Rupture of Splenic Artery Aneurysm Which Was Located Distally

Mentions: A 27 year-old male referred to the emergency department of our hospital suffering from abdominal pain. His medical history was unremarkable. He was treated symptomatically for 2 days. On admission the patient was conscious. Signs such as dry mouth and pale conjunctiva, were significant. A primary symptom was hypotension. After fluid resuscitation, his pulse rate was 100 beats/min, blood pressure: 100/60 mm/Hg, respiratory rate: 16/min and body temperature: 37°C. His abdomen was not distended, bowel sounds were normal and generalized abdominal tenderness without guarding or rebound tenderness was remarkable. Digital rectal examination (DRE) was normal. Laboratory test results showed mild anemia and leukocytosis with hemoglobin concentration 10g/dl, hematocrit 31%, leukocyte count 14 × 103/µl, platelet count 240× 103/µl. Urine analysis (UA) was normal. FAST (focused abdominal sonography for trauma) revealed free fluid in the abdominal pelvic cavity. After performing FAST, re-evaluation of vital signs were: blood pressure 90/60 mm/Hg, and heart rate 138/min, urine output 30cc/h. Based on haemoperitoneum and the unstable vital signs, the patient underwent exploratory laparotomy; there was 600ccs of blood in the free peritoneal cavity. Moreover, blood accumulation within the peritoneal cavity and retroperitoneal space at the left upper quadrant was detected. The cause of bleeding was rupture of a splenic artery aneurysm located near the hilus (Figure 1 A). Spleen examination was normal, but splenic artery aneurysm was found at the distal part of the splenic artery. Pathological evaluation of proximal ligation followed by aneurysmectomy and splenectomy was performed (Figure 1 B). The postoperative course was monotonous and the patient was discharged on the fifth postoperative day with complete recovery. Histopathological assessment revealed attenuated muscular layer with increased amount of collagen fibers and proliferation of medial vessels with hypertrophic and aneurysmal vascular wall with thrombus (Figures 2 and 3). Congested spleen and unremarkable lymph nodes were also evident.


Ruptured aneurysm of the splenic artery: a rare cause of abdominal pain after blunt trauma.

Khoshnevis J, Lotfollahzadeh S, Sobhiyeh MR, Najd Sepas H, Abbas Nejad M, Rahbari A, Behnaz N, Mahdi Z - Trauma Mon (2013)

Rupture of Splenic Artery Aneurysm Which Was Located Distally
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3860647&req=5

fig3464: Rupture of Splenic Artery Aneurysm Which Was Located Distally
Mentions: A 27 year-old male referred to the emergency department of our hospital suffering from abdominal pain. His medical history was unremarkable. He was treated symptomatically for 2 days. On admission the patient was conscious. Signs such as dry mouth and pale conjunctiva, were significant. A primary symptom was hypotension. After fluid resuscitation, his pulse rate was 100 beats/min, blood pressure: 100/60 mm/Hg, respiratory rate: 16/min and body temperature: 37°C. His abdomen was not distended, bowel sounds were normal and generalized abdominal tenderness without guarding or rebound tenderness was remarkable. Digital rectal examination (DRE) was normal. Laboratory test results showed mild anemia and leukocytosis with hemoglobin concentration 10g/dl, hematocrit 31%, leukocyte count 14 × 103/µl, platelet count 240× 103/µl. Urine analysis (UA) was normal. FAST (focused abdominal sonography for trauma) revealed free fluid in the abdominal pelvic cavity. After performing FAST, re-evaluation of vital signs were: blood pressure 90/60 mm/Hg, and heart rate 138/min, urine output 30cc/h. Based on haemoperitoneum and the unstable vital signs, the patient underwent exploratory laparotomy; there was 600ccs of blood in the free peritoneal cavity. Moreover, blood accumulation within the peritoneal cavity and retroperitoneal space at the left upper quadrant was detected. The cause of bleeding was rupture of a splenic artery aneurysm located near the hilus (Figure 1 A). Spleen examination was normal, but splenic artery aneurysm was found at the distal part of the splenic artery. Pathological evaluation of proximal ligation followed by aneurysmectomy and splenectomy was performed (Figure 1 B). The postoperative course was monotonous and the patient was discharged on the fifth postoperative day with complete recovery. Histopathological assessment revealed attenuated muscular layer with increased amount of collagen fibers and proliferation of medial vessels with hypertrophic and aneurysmal vascular wall with thrombus (Figures 2 and 3). Congested spleen and unremarkable lymph nodes were also evident.

Bottom Line: Herein we present a young patient with abdominal pain after blunt abdominal trauma due to rupture of an SAA.A 27-year-old male, without a remarkable medical history, who suffered from abdominal pain for 2 days after falling was admitted to the emergency department with hypovolemic shock.Upon performing emergency laparotomy a ruptured splenic artery aneurysm was found.

View Article: PubMed Central - PubMed

Affiliation: Department of Vascular Surgery, Shahid Beheshti University of Medical Sciences and Health Services, Shohadaye Tajrish Hospital, Tehran, IR Iran.

ABSTRACT

Introduction: Splenic artery aneurysms (SAAs) are rare (0.2-10.4%); however, they are the most common form of visceral artery aneurysms. Splenic artery aneurysms are important to identify, because up to 25% of the cases are complicated by rupture. Post- rupture mortality rate is 25% -70% based on the underlying cause. Herein we present a young patient with abdominal pain after blunt abdominal trauma due to rupture of an SAA.

Case presentation: A 27-year-old male, without a remarkable medical history, who suffered from abdominal pain for 2 days after falling was admitted to the emergency department with hypovolemic shock. Upon performing emergency laparotomy a ruptured splenic artery aneurysm was found.

Conclusions: It is important to consider rupture of a splenic artery aneurysm in patients with abdominal pain and hypovolemic shock.

No MeSH data available.


Related in: MedlinePlus