ABSTRACT
The splenic artery is a common site of intraabdominal aneurysms. Very few patients present with symptoms before a splenic artery aneurysm ruptures. However, the symptoms vary depending on the type of aneurysm. Some patients present with hemodynamic shock, while others develop mild lumbago, anemia, or syncope. Thus, it is sometimes difficult to diagnose and treat ruptured splenic aneurysms. We report a rare case of rupture of a small splenic artery aneurysm, which remained undetected for 3 months after the appearance of the first symptoms, i.e., anemia and melena, despite conducting different examinations at our hospital. A 74-year-old man who underwent a graft replacement of an abdominal aortic aneurysm in 2006 complained of melena in May 2011. He was severely anemic, but presented with no other symptoms. A 16-mm-diameter splenic aneurysm was detected during a previous operation. The splenic artery aneurysm, as seen on computer tomography (CT) scans, showed no significant change in diameter for 5 years. The patient underwent upper and lower gastrointestinal endoscopy, capsule endoscopy, and enhanced CT at the Department of Gastroenterology to determine the site of the bleeding. However, the source of the bleeding was unclear. Finally, a diagnosis by elimination was made and the cause of the melena was identified as a ruptured splenic aneurysm. The splenic artery aneurysm was treated with coil embolization, and the patient's anemia was cured. The splenic artery aneurysm ruptured and bled into the pancreatic duct. The findings of this case suggest that a small splenic artery aneurysm rupture might not cause major symptoms like hemodynamic shock or large hematomas that can be identified on CT scans, but they may bleed into visceral organs. Therefore, interventions for the treatment of a non-symptomatic abdominal visceral artery aneurysm should be carried out promptly.
ABSTRACT
We describe successful resection and anatomical revascularization in 2 men aged 75- and 50 who suffered from prolonged systemic infection. Blood culture was positive in both cases, <i>Klebsiella pneumoniae</i> and <i>Staphylococcus aureus</i> (MSSA), respectively. Case 1 was misdiagnosed as acute appendicitis and underwent laparotomy. Postoperative CT revealed leaking aneurysm. Case 2 was diagnosed correctly on screening CT. Bacterial culture of all surgical specimens proved negative. The postoperative course was fortunately uneventful. The early and accurate diagnosis of infected aneurysm is important to establish surgical strategy. Timing of surgical intervention is still difficult to determine for minimizing the risk of graft infection.
ABSTRACT
Cardiac injury following blunt chest trauma requires immediate transportation, correct diagnosis and early surgical treatment. We present 2 cases of rare cardiac rupture, right auricular laceration and multiple ruptures of vena cava, respectively. Case 1: An 18-year-old male driver was transported to a local hospital in a state of shock immediately after a traffic accident. Chest CT demonstrated cardiac tamponade. After temporary hemodynamic improvement by pericardiocentesis, he was referred to our hospital. Since his blood pressure decreased below the measurable threshold in the ICU, he was transferred to the OR after emergency subxiphoid pericardial drainage. On opening the pericardium after full sternotomy, the right atrial appcndage laceration was found, about 1cm in length, and was sutured easily without cardiopulmonary bypass or any transfusion. Postoperative recovery was uneventful. Case 2: A 19-year-old male driver was directly transferred in an apneic shock state. Chest CT revealed cardiac tamponade. Full sternotomy was promptly carried out in the ICU after cardiopulmonary resuscitation (CPR) and subxiphoid pericardial drainage. Caval injury was found, 2cm in length, in both the superior vena cava (SVC) and intrapericardial inferior vena cava (IVC). His circulatory state was restored after the repair of these caval injuries without cardiopulmonary bypass; however, he died from severe brain damage postoperatively. In summary, blunt rupture of the right heart could be saved by prompt transport with airway assist, pericardial drainage, and proper surgery.
ABSTRACT
A 70-year-old man was admitted to our hospital because of cough and dyspnea. On the 7th hospital day, he suddenly suffered by severe pulmonary congestion and bilateral pleural effusion with a prominent heart murmur. After improvement of the symptoms, 3-D CT scan and cardiac catheterization confirmed patent ductal aneurysm of about 10.5cm in diameter. Because of pulmonary hemorrhage, an emergency operation was performed using a left thoracotomy approach. A large aneurysmal mass of about 12cm in diameter was transected and the pulmonary end and aortic end of the ductus arteriosus were closed using a patch under partial cardiopulmonary bypass. His postoperative course was uneventful and he was discharged on the 27th day after operation.
ABSTRACT
A 13-month-old girl (BW 4476g) with Taussig-Bing malformation was successfully treated by anterior intraventricular tunnel repair (Patrick-McGoon method). She had large subpulmonary malalignment ventricular septal defect with extreme inflow extension with anteroposterior relationship of the great arteries. Coronary arterial anatomy was a very rare type in that LAD branching from RCA originated from right facing sinus was running just anterior to the aorta and coronary relocation would result in straining and obstructing LAD. Intraventricular tunnel through the VSD to the aorta was tailored by use of a double velour Dacron conduit (14mm in diameter) and inflow extension of VSD was partly closed with a separate flat Dacron patch. LVOTO was not found on echocardiography and good clinical results were obtained at 11 months postoperatively.