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 study the factors related to development of pancreatic fistula after laparoscopic distal pancreatectomy.Methods:The clinical data of all patients who underwent laparoscopic distal pancreatectomy at the Second Hospital of Hebei Medical University from January 2019 to December 2020 were retrospectively analyzed. Gender, age, intraoperative blood loss, treatment of pancreatic stump, body mass index (BMI), pancreatic texture, albumin and other indicators were analyzed between patients with and without pancreatic fistula. Logistic regression analysis was used to determine independent risk factors for pancreatic fistula.Results:Of 93 patients in this study, there were 33 males and 60 females, mean age (49.23±15.62), range 16 to 76 years. The incidence of postoperative pancreatic fistula was 34.4% (32/93). On univariate analysis, BMI (χ 2=4.515, P=0.034), pancreatic texture (χ 2=3.891, P=0.049), preoperative serum albumin ( t=2.644, P=0.010) and albumin difference ( t=-2.293, P=0.024) were significantly associated with postoperative pancreatic fistula. Multivariate logistic regression analysis showed that low preoperative albumin ( OR=0.551, P<0.001), large difference in albumin ( OR=1.542, P<0.001), BMI≥25 kg/m 2 ( OR=3.303, P=0.035) and soft pancreatic texture ( OR=3.065, P=0.049) were independent risk factors for pancreatic fistula. Conclusion:For patients with BMI≥25 kg/m 2 and patients with a soft pancreas, there was a higher chance to develop pancreatic fistula after operation.