A Small Ruptured Splenic Artery Aneurysm Presenting as Anemia and Melena after Graft Replacement of an Abdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

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.

A Case of Spontaneous Rupture of a Splenic Artery Aneurysm in the Third Trimester / 대한산부인과학회잡지

The spontaneous rupture of splenic artery aneurysm during pregnancy is a rare but catastrophic event. Two thirds of all ruptures happen during the third trimester. Clinical presentation is often non-specific, with good hemodynamic compensation, followed by a rapid deterioration. Active management and operation are the most important procedures for diagnosis and therapy of the bleeding. Abdominal delivery will help to establish diagnosis and should be performed immediately. We report a case of a patient at 38 weeks of gestation suffering epigastric pain and fetal distress. At emergency cesarean delivery, an aneurysmal rupture of the splenic artery was found to be the reason for the hemoperitoneum. Spleen, aneurysm and the tail of the pancreas were removed. In spite of fatal hemorrhage, the patient survived but her fetus was dead. With a review of the literature on this topic, diagnostic aspects and treatment options are discussed.