ABSTRACT
Those women underwent removal of splenic artery aneurysm. One of them was admitted because of intraperitoneal bleeding. Further examination showed rupture of a splenic artery aneurysm with the delayed rupture phenomenon. Emergency laparotomy was perfomed. Splenic aneurysmectomy and splenectomy were successfully carried out. The two other cases of splenic artery aneurysm were detected accidentally. One was complicated by aortic abdominal aneurysm and the other by cholelithiasis. Each patient received two different types of operations at the same time. Splenic aneurysm is likely to be overlooked because of lack of symptoms. However, even a small aneurysm has the possibility of rupture. Therefore, an early operation is recommended.
ABSTRACT
Surgical mortality associated with ruptured abdominal aneurysm remains high, especially in elderly patients, despite recent progress in improved patient management. We present the successful salvage of a 90-year-old woman with ruptured abdominal aortic aneurysm. She was transferred from another hospital because of severe abdominal and back pain and pulsatile abdominal tumor. One hour after admission, shock suddenly developed. We diagnosed her illness as ruptured abdominal aneurysm on enhanced CT scan. Emergency surgery was performed. The hematoma surrounding the aneurysm occupied the retroperitoneal space below the level of the diaphragm (Fitzgerald III). Aortic cross clamp was quickly performed below the level of the diaphragm approaching from the lesser omentum. After controlling bleeding, the site of the aortic cross clamping was changed to the infrarenal aorta. The aneurysm was resected and replaced by a knitted Dacron Y-graft (albumin coated). Duration of surgery was 5 hours and 5 minutes. Blood loss was 6200ml. After surgery, artificial ventilation was required for ten days to avoid hypoxemia. On the 5th postoperative day disseminated intravascular congulation (DIC) developed but she recovered. On the 30th postoperative day, she was discharged. Advanced age may not be an absolute contraindication for surgical treatment even in cases of rupture.