ABSTRACT
Abstract True splenic artery aneurysms are exceedingly rare and the medical literature contains only a limited number of reports on this pathology. Presently, there remains a lack of consensus regarding the optimal management and treatment approaches for patients in this category. Over the course of the last century, significant changes have occurred in the realm of surgical options, transitioning from open and endovascular procedures to the more advanced laparoscopic and robotic interventions. The propensity for these aneurysms to rupture underscores the need for timely intervention. The risk of rupture is notably elevated in patients harboring giant splenic artery aneurysms. In this report, we present the case of a 55-year-old woman diagnosed with a giant splenic artery aneurysm measuring 12x12 cm in diameter. She presented with notable weakness, discomfort, and pain in the left subcostal area. In response to her complaints and after thorough evaluation, we opted for a surgical procedure encompassing distal pancreatic resection in conjunction with splenectomy and resection of the giant splenic artery aneurysm.
Resumo Os aneurismas verdadeiros da artéria esplênica são extremamente raros, e há um número limitado de relatos sobre essa condição na literatura médica. Atualmente, não há consenso sobre as abordagens ideais de manejo e tratamento para pacientes que se enquadram nessa categoria. Ao longo do século passado, ocorreram mudanças significativas no domínio das opções cirúrgicas, passando de procedimentos abertos e endovasculares para intervenções laparoscópicas e robóticas mais avançadas. A propensão à ruptura do aneurisma ressalta a necessidade de intervenção em tempo oportuno. O risco de ruptura é notavelmente elevado em pacientes com aneurismas gigantes da artéria esplênica. Neste relato, apresentamos o caso de uma mulher de 55 anos diagnosticada com aneurisma gigante de artéria esplênica medindo 12x12 cm de diâmetro. A paciente apresentava fraqueza notável, desconforto e dor na região subcostal esquerda. Em resposta às suas queixas e após avaliação minuciosa, optamos por um procedimento cirúrgico que incluiu pancreatectomia distal associada a esplenectomia e ressecção do aneurisma gigante da artéria esplênica.
ABSTRACT
Objective To investigate the clinical value of preventative surgical resection in the treatment of extra-hepatic portal vein aneurysm.Methods The method of retrospective descriptive study was conducted.The clinical data of 1 patient with extra-hepatic portal vein aneurysm who was admitted to the Guangzhou General Hospital of Guangzhou Military Command of PLA in May 2014 were collected.The patient suffered from dull pain in his epigastrium,with no obvious causative factors.The patient recieved abdominal B-ultrasound,CT scans abdominal and superior mesenteric artery,angiographies after admission in May 2014,and was diagnosed as with extra-hepatic portal vein aneurysm.The preventative surgical resection was selected according to the patient's individual health status.Extra-hepatic portal vein aneurysm resection was conducted under the guidance of intraoperative ultrasonography after abdominal exploration.A double-cavity drainage tube was placed in the venturis hole when portal vein aneurysm was dissected and removed.Then the abdomen was closed.The patient received regular perioperative management.The operation time,volume of intraoperative blood loss,time for diet recovery,time of drainage tube removal,postoperative complications,results of laboratory tests,results of imaging findings,healing of incision,time of postoperative discharge from hospital,results of pathologic examination and follow-up were observed.Follow-up using outpatient examination or telephone interview was performed to detect the inspect status of portal vein and inspect recurrence of portal vein aneurysm by abdominal B-ultrasound and CT examinations till December 2014.Results The patient underwent successful extra-hepatic portal vein aneurysm resection.The operation time was 85 minutes and the volume of intraoperative blood loss was around 150 mL.The patient gradually returned to normal diet and self-care ability at postoperative day 3,and the abdominal drainage tube was removed at postoperative day 3.No postoperative complications including hemorrhage,portal vein thrombosis and dysfunction of liver were detected after operation.There were normal levels of blood routine and blood biochemical test.Postoperative B-ultrasound examination showed smooth blood flow in portal vein and the abdominal blood vessel CT angiography presented clear image of the portal vein,with smooth blood flow and normal lumen.The surgical incision recovered very well and the patient was discharged from hospital at postoperative day 9.Results of postopeartive pathologic examination showed that there were cystic-like tissues with simple squamous epithelium cells on the interior,the wall of which consisted of smooth muscle was in accordance of the structure of vein.The patient didn't receive any other special treatment or take medicines postoperatively.The patient had good physical health and can take care of himself during six-month follow-up,without narrow portal vein,recurrence of portal vein aneurysm and other complications.Conclusion Preventative surgical resection is safe and feasible for extra-hepatic portal vein aneurysm,with a good efficacy.