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ABSTRACT Objective: to evaluate the morphology of the branches of celiac trunk (CT), left gastric (LGA), common hepatic (CHA), and splenic (SA) arteries in cadaveric specimens from a sample of a Colombian population. Methods: descriptive cross-sectional study of 26 blocks from the abdominal upper segment of human cadavers who underwent forensic autopsies at the Instituto de Medicina Legal at Bucaramanga, Colombia. The vascular beds of the celiac trunk were, subsequently, perfused with a semi-synthetic resin. Results: the diameters of LGA, CHA, and SA were 3.6±0.8mm, 5,2±1.2mm, and 5.9±1.0mm, respectively. Statistically, LGA and SA were different (p=<0.001). SA followed a linear trajectory in 8 (31%) samples, slightly tortuous in 4 (15%), and tortuous in 14 (54%). The tortuosity index was 1.25±0.18. Of the branches of CHA, the proper hepatic artery (PHA) had 4.8±1.2mm in diameter and 18.8±9.1mm in length, whereas the gastroduodenal artery (GDdA) had 4.1±0.8mm. In 2 cases (7.7%), an accessory hepatic artery from the LGA was found to supply perfusion to the left hepatic lobe. Finally, in 2 cases (7.7%) the SA came independently from the abdominal aorta. Conclusion: the observed emergence incidence of the CT branches from the same level as reported in the literature is lower. The characterization, along with their variants, of LGA, CHA, and SA must be considered in surgical procedures in the upper abdominal segment, to avoid iatrogenic complications.
RESUMO Objetivo: avaliar a morfologia dos ramos das artérias do tronco celíaco (CT), gástrica esquerda (LGA), hepática comum (HC) e esplênica (SA) em espécimes cadavéricos de uma amostra de uma população colombiana. Métodos: estudo transversal descritivo de 26 blocos do segmento superior abdominal de cadáveres humanos submetidos a necropsias forenses no Instituto de Medicina Legal de Bucaramanga, Colômbia. Os leitos vasculares do tronco celíaco foram, posteriormente, perfundidos com resina semissintética. Resultados: os diâmetros de LGA, CHA e SA foram 3,6±0,8mm, 5,2±1,2mm e 5,9±1,0mm, respectivamente. Estatisticamente, LGA e SA foram diferentes (p=<0,001). A SA seguiu uma trajetória linear em 8 (31%) amostras, levemente tortuosa em 4 (15%) e tortuosa em 14 (54%). O índice de tortuosidade foi de 1,25±0,18. Dos ramos do ACS, a artéria hepática própria (APH) tinha 4,8±1,2mm de diâmetro e 18,8±9,1mm de comprimento, enquanto a artéria gastroduodenal (GDdA) tinha 4,1±0,8mm. Em 2 casos (7,7%), uma artéria hepática acessória do GIG foi encontrada para fornecer perfusão ao lobo hepático esquerdo. Finalmente, em 2 casos (7,7%) a SA veio independentemente da aorta abdominal. Conclusão: a incidência observada de emergência dos ramos de TC do mesmo nível relatado na literatura é menor. A caracterização, juntamente com suas variantes, de LGA, CHA e SA deve ser considerada em procedimentos cirúrgicos no segmento abdominal superior, para evitar complicações iatrogênicas.
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Introducción: Evidencias indican que la arteria esplénica presenta un patrón común al tener en cuenta: origen, trayecto y terminación; sin embargo, en ocasiones pueden aparecer variantes anatómicas de importancia elemental para las especialidades quirúrgicas. Objetivo: Describir el patrón común y las variantes anatómicas del sistema arterial esplénico en el hombre adulto. Métodos: Se realizó un estudio descriptivo, transversal con un universo conformado por todos los bloques anatómicos existentes en el departamento, cuya muestra no probabilística a criterio de los autores quedó constituida por 25 bloques anatómicos. La información fue recogida en un formulario contentivo de las variables objeto de estudio. Se caracterizó el patrón común y las variantes anatómicas de la arteria esplénica considerando el origen, trayecto, ramas colaterales y ramas terminales. Se determinó la longitud y el diámetro externo en el origen y terminación de la arteria esplénica. Las piezas anatómicas fueron adquiridas mediante convenio cumpliendo los aspectos éticos establecidos. Para la recolección de la información se confeccionó un formulario contentivo de las variables que fueron objeto de estudio y los resultados procesados en Excel mediante el software estadístico SPSS 25.0. Resultados: En la mayoría de las piezas anatómicas predominó el patrón común de la arteria esplénica correspondiente al 88 % y solo se observaron variantes de la norma en tres bloques representando el 12 %. Prevaleció el trayecto sinuoso en 22 piezas, mientras que en dos se observó el serpenteado y en una pieza el rectilíneo. La longitud máxima encontrada de la arteria esplénica fue de 205 mm mientras que la longitud mínima de 102 mm. Conclusiones: Se observó el patrón común según origen, trayecto y terminación de la arteria esplénica sobre las variantes anatómicas.
Introduction: Evidence indicates that the splenic artery presents a common pattern taking into account: origin, route and termination, however, sometimes anatomical variants of elementary importance for surgical specialties may appear. Objective: To describe the common pattern and the anatomical variants of the splenic arterial system in the adult man. Methods: A cross-sectional descriptive study with a universe made up of all the anatomical blocks existing in the department was carried out, whose noon-probabilistic sample at the authors discretion was made up of 25 anatomical blocks. The information was collected in a form containing the variables under study. The common pattern and the anatomical variants of the splenic artery were characterized considering the origin, route, collateral branches and terminal branches. The length and external diameter at the origin and termination of the splenic artery were determined. The anatomical pieces were acquired by agreement complying with the established ethical aspects. For the collection of information, a form containing the variables under study and the results processed in Excel using the statistical software SPSS 25.0 was prepared. Results: In most of the anatomical pieces, the common pattern of the splenic artery prevailed, corresponding to 88% and only variants of the norm were observed in 3 blocks, representing 12 %. The winding path predominated in 22 pieces, while in 2 pieces presented a serpentine path was observed and in 1 piece rectilinear one. The maximum length found of the splenic artery was 205 mm while the minimum length was 102 mm. Conclusions : The common pattern prevailed according to origin, route and termination of the splenic artery prevailed over the anatomical variants.
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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.
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La hemorragia digestiva determinada por una fístula entre manga gástrica y seudoaneurisma de arteria esplénica o polo superior de bazo es infrecuente. Se presenta un caso clínico de una paciente de 52 años con antecedentes de cirugía de manga gástrica y fuga anastomótica. Ingresó por hemorragia digestiva alta grave. Se operó de emergencia y realizó punto hemostático sobre cara posterior de manga gástrica. Se reintervino por resangrado realizándose la gastrectomía y esplenopancreatectomía distal por solución de continuidad de arteria esplénica. Dada la inestabilidad hemodinámica se efectuó un esofagostoma y yeyunostomía, reconstruyéndose a los 8 meses con buena evolución.
Gastrointestinal bleeding caused by a fistula between the gastric sleeve and a pseudoaneurysm of the splenic artery or upper pole of the spleen is uncommon. A clinical case of a 52-year-old patient with a history of gastric sleeve surgery and anastomotic leak is presented. She was admitted for severe upper gastrointestinal bleeding. She underwent emergency surgery and performed a hemostatic stitch on the posterior face of the gastric sleeve. She underwent reoperation due to rebleeding, performing gastrectomy and distal splenopancreatectomy due to discontinuation of the splenic artery. Given the hemodynamic instability, an esophagostomy and jejunostomy were performed, reconstructing at 8 months with good evolution.
O sangramento gastrointestinal causado por uma fístula entre a manga gástrica e um pseudoaneurisma da artéria esplênica ou pólo superior do baço é incomum. Apresenta-se o caso clínico de um paciente de 52 anos com história de cirurgia de manga gástrica e fístula anastomótica. Ele foi internado por hemorragia digestiva alta grave. Uma operação de emergência foi realizada e um ponto hemostático foi realizado na face posterior da manga gástrica. Foi reoperado por ressangramento, realizando gastrectomia e esplenopancreatectomia distal por descontinuação da artéria esplênica. Dada a instabilidade hemodinâmica, foi realizada esofagostomia e jejunostomia, reconstruindo aos 8 meses com boa evolução.
Subject(s)
Humans , Female , Middle Aged , Splenic Artery/pathology , Gastric Fistula/complications , Bariatric Surgery/adverse effects , Gastrectomy , Gastrointestinal Hemorrhage/surgery , Postoperative Complications , Catastrophic Illness , Emergencies , Gastrointestinal Hemorrhage/etiologyABSTRACT
Objective:To study the impact of simultaneous ligation of splenic artery on prognosis of patients with severe hypersplenism in liver transplantation.Methods:A retrospective analysis was performed on the clinical data of 206 patients who underwent liver transplantation in the Fifth Medical Center of PLA General Hospital from December 2016 to February 2019. There were 180 males and 26 females, aged (51.0±9.0) years old. Fifty-one patients underwent splenic artery ligation during liver transplantation and they were enrolled into the observation group, and 155 patients without splenic artery ligation were enrolled into the control group. The changes in white blood cells (WBC), platelets, alanine aminotransferase, total bilirubin and serum creatinine as well as the incidence of postoperative complications were compared between the two groups.Results:The platelet count of the observation group was significantly lower than those of the control group before operation and on days 1, 3, 7, 30 and 90 after operation, (all P<0.05). The WBC counts in the observation group were significantly lower than those in the control group before operation and on days 1 and 3 after operation (all P<0.05). However, there were no significant differences in the WBC counts between the two groups on days 5, 7, 30 and 90 after operation (all P>0.05). There were also no significant differences in alanine aminotransferase and total bilirubin indexes between the two groups after surgery (all P>0.05), but the serum creatinine levels in the observation group were significantly lower than those in the control group on days 3, 5, 7 and 30 after surgery (all P<0.05). There were no significant differences in the rates of infection, severe acute rejection, biliary tract complications, arterial/portal thrombosis and mental complications between the two groups (all P>0.05). The rate of renal replacement therapy for acute kidney injury in the observation group (9.8%, 5/55) was significantly higher than that in the control group (1.3%, 2/155) ( P<0.05). Conclusion:Ligation of splenic artery during liver transplantation was safe and it had a significant advantage in the early postoperative recovery of WBC count and creatinine without increasing the incidence of complications in patients with severe hypersplenism.
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Objective:To investigate the clinical value of totally laparoscopic exclusion of splenic artery aneurysm combined with pericardial devascularization for portal hypertension com-plicated with splenic aneurysm.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 17 patients with portal hypertension complicated with splenic aneurysm who were admitted to 2 medical centers (15 cases in Shenzhen University General Hospital and 2 cases in Wuhan First Hospital) from January 2013 to May 2020 were collected. There were 7 males and 10 females, aged (59±14)years. All patients underwent totally laparoscopic exoclusion of splenic artery aneurysm combined with pericardial devascularization. Observation indicators : (1) surgical and postoperative conditions; (2) complications; (3) follow-up. Follow-up was conducted by out-patient examiantion and telephone interview to detect the effect of exclusion of arterial tumor, and blood re-flow, portal vein thrombosis and survival of patients 3 months after operation. The follow-up was up to December 2020. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Results:(1) Surgical and postoperative conditions. All 17 patients successfully completed the operation, without perioperative death. The operation time, volume of intraoperative blood loss of 17 patients were (181±30)minutes, 187(range, 90?420)mL. The white blood cell count, red blood cell count, hemoglobin, serum albumin were (9±4)×10 9/L, (3.5±0.9)×10 12/L, (86±17)g/L, (36±7)g/L on the postoperative day 3. Time to postoperative abdominal drainage tube removal and duration of post-operative hospital stay were (7±4)days and (11±4)days. (2) Complications. All 17 patients had ascites after surgery, which were improved after oral treatment with diuretics. There was no complication such as intra-abdominal hemorrhage, gastrointestinal fistula, pleural effusion, infection, abscess formation, fever and vascular embolism. (3) Follow-up. All the 17 patients were followed up for 28.6(range, 7.0?84.0)months. During the follow-up, the splenic aneurysm cavity of all patients was completely isolated, no blood re-flow and no portal vein thrombosis was observed, and no patient died. Conclusion:Totally laparoscopic exclusion of splenic artery aneurysm combined with pericardial devascularization is safe and feasible in the treatment of portal hypertension complicated with splenic aneurysm.
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Objective: To analyze the association of No.11p posterior lymph node metastasis with clinicopathological features and its prognostic significance in gastric cancer. Methods: A single-center retrospective cohort study was conducted. Clinicopathological data of patients with primary gastric cancers undergoing No.11p posterior lymph node dissection from January 2016 to December 2020 were retrieved from the Database of Gastric Cancer, West China Hospital, Sichuan University. Case inclusion criteria: (1) gastric cancer proved by pathology; (2) radical resection with intraoperative No.11p posterior lymph node dissection; (3) operations performed by the same surgical team; (4) no previous history of other malignant tumors and no concurrent malignant tumors. Those with stump gastric cancer, history of gastrectomy, neoadjuvant chemotherapy, incomplete clinicopathological data and lost to follow-up were excluded. During the operation, the upper edge of the pancreas was retracted forward to expose the area between the upper edge of the pancreas and the splenic vessels. The proximal segment of the splenic artery was skeletonized to remove lymphatic tissue anterior and superior to the splenic artery for No.11p lymph node dissection. For patients with lymphadenopathy in the area between the splenic artery and the splenic vein, dissection was performed. The enlarged lymph nodes were labeled with titanium clips and named as No.11p posterior lymph node. Pathological examination was performed separately after the specimen was isolated. Statistical analysis was performed using R software. Results: A total of 127 gastric cancer patients, who underwent No.11p posterior lymph nodes dissection were included in this study, of which 120 patients without No.11p posterior lymph nodes metastasis (No.11p posterior lymph nodes negative) and 7 patients with No.11p posterior lymph nodes metastasis (No.11p posterior lymph nodes positive). A total of 8 metastatic No.11p posterior lymph nodes were detected in 7 patients, metastasis rate and with a ratio of 5.5% (7/127) and 6.8% (8/127), respectively. In the subgroup analysis of T3-4 stage patients, the metastasis rate and ratio of No.11p posterior lymph nodes were 9.0% (7/78) and 10.7% (8/75), respectively. Compared to negative cases, patients with No.11p posterior lymph nodes metastasis had larger tumor (P=0.002), higher proportion of Borrmann type Ⅲ and Ⅳ tumors (P=0.005), more metastatic lymph nodes (P<0.001), more advanced T stage (P=0.043), N stage (P=0.004) and TNM stage (P=0.015). In survival analysis, patients with No.11p posterior lymph node metastasis had a significantly worse prognosis than those without metastasis after adjusting for TNM stage (hazard ratio=3.009, 95% confidence interval: 1.824-4.964, P<0.001). Conclusions: The No.11p posterior lymph node metastasis in gastric cancer is associated with worse prognosis. For patients of T3-4 stage gastric cancer, No.11p posterior lymph node dissection should be emphasized during radical operation.
Subject(s)
Humans , Gastrectomy , Lymph Node Excision , Lymph Nodes/pathology , Lymphatic Metastasis/pathology , Prognosis , Retrospective Studies , Stomach Neoplasms/pathologyABSTRACT
Abstract Splenic artery pseudoaneurysm is the most common of all the visceral artery pseudoaneurysms. Presentation is often variable and the condition demands immediate diagnosis and management because pseudoaneurysm rupture increases morbidity and mortality. It is associated with pancreatitis and other conditions like abdominal trauma, chronic pancreatitis, pseudocyst of the pancreas, liver transplantation, and, rarely, peptic ulcer disease. We present a case of a giant splenic artery pseudoaneurysm measuring 14x8 cm. Proximal and distal control of the vessels could not be achieved during the procedure because of local adhesions and inflammation and it was necessary to cross clamp the supraceliac aorta to control bleeding.
Resumo O pseudoaneurisma de artéria esplênica é o mais comum entre os pseudoaneurismas de artérias viscerais. A apresentação geralmente varia e requer diagnóstico e tratamento imediatos, pois a ruptura do pseudoaneurisma aumenta a morbimortalidade. Esse tipo de pseudoaneurisma está associado à pancreatite e a outras condições, como trauma abdominal, pancreatite crônica, pseudocisto de pâncreas, transplante de fígado e, raramente, úlcera péptica. Apresentamos um caso de pseudoaneurisma gigante de artéria esplênica, com tamanho de 14x8 cm. Durante o procedimento, não foi possível alcançar controle proximal e distal dos vasos devido a aderências locais e inflamação, sendo necessário o clampeamento da aorta supracelíaca para controle do sangramento.
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ABSTRACT Objective: to determine the prevalence and describe the main morphological and metric variations of the splenic artery in terms of its origin, path and polar and terminal branches. Methods: cross-sectional study, carried out at Hospital de Clínicas between July and November 2020. Computed tomography scans were analyzed with intravenous contrast of the patients seen at the Radiology and Diagnostic Imaging Service. The findings were categorized as to origin, path and splenic ramifications. Results: 1,235 patients were evaluated. As for the origin, the splenic artery appears in the celiac trunk in 99.11% of the individuals. Of these, 5.95% have a bifurcated celiac pattern, 92.17% trifurcated and 1.88% tetrafurcated. The mean arterial diameter was 5.92mm (±1.2), the highest one being in white men. As for the path, the splenic artery was unique in the entire sample. The suprapancreatic course was found in 75.63% of the individuals, with a higher occurrence in women, 78.87% (p<0.001). The terminal splitting pattern of the splenic artery was characterized by the bifurcated type (95.47%). The terminal branches seen most frequently were those with three arteries (34.90%) and most individuals did not have polar branches. Conclusion: the splenic artery presents a highly variable pattern of origin and its average caliber is influenced by sex and color. The suprapancreatic path was the most characteristic and predominant in females. The bifurcated pattern of final division, with three terminal branches and the absence of polar arteries, occurs more frequently.
RESUMO Objetivo: determinar a prevalência e descrever as principais variações morfológicas e métricas da artéria esplênica quanto a sua origem, trajeto e ramos terminais e polares. Métodos: estudo transversal, realizado no Hospital de Clínicas entre julho e novembro de 2020. Foram analisadas tomografias computadorizadas com contraste endovenoso dos pacientes atendidos no Serviço de Radiologia e Diagnóstico por Imagem. Os achados foram categorizados quanto à origem, trajeto e ramificações esplênicas. Resultados: foram avaliados 1.235 pacientes. Quanto à origem, a artéria esplênica surge no tronco celíaco em 99,11% dos indivíduos. Desses, 5,95% apresentam padrão celíaco bifurcado, 92,17% trifurcado e 1,88% tetrafurcado. O diâmetro arterial médio foi de 5,92mm (±1,2), sendo a maior média em homens brancos. Quanto ao trajeto, a artéria esplênica se apresentou única em toda a amostra. O curso suprapancreático esteve em 75,63% dos indivíduos, com maior ocorrência em mulheres 78,87% (p<0,001). O padrão de divisão terminal da artéria esplênica caracterizou-se pelo tipo bifurcado (95,47%). Os ramos terminais visualizados mais frequentemente foram os com três artérias (34,90%) e a maioria dos indivíduos não apresentou ramos polares. Conclusão: a artéria esplênica apresenta padrão de origem altamente variável e seu calibre médio é influenciado por sexo e cor. O trajeto suprapancreático foi o mais característico e predominou no sexo feminino. O padrão bifurcado de divisão final, com três ramos terminais e ausência de artérias polares, ocorre com maior frequência.
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RESUMEN: El tronco celíaco (TC) es la rama de la arteria aorta abdominal (AA) que aporta la irrigación a la porción distal del esófago, parte media del duodeno, al estómago, páncreas, bazo y suple adicionalmente al hígado; sus diferentes expresiones anatómicas son reportadas en los diferentes grupos poblacionales con incidencia variable. Se evaluó las características morfológicas del TC y sus ramas en 26 bloques del piso supramesocólico de cadáveres masculinos adultos no reclamados, del grupo poblacional mestizo, a quienes se les practico autopsia en el Instituto de Medicina Legal de Bucaramanga - Colombia. Se observo el tipo I del TC en 23 especímenes (88,4 %), del cual correspondió 16 muestras (61,5 %). Al subtipo Ia con bifurcación y formación de tronco hepatoesplénico. Hubo un caso (3,8 %) en donde las ramas del T se originaron de manera independiente de la AA. El TC presentó una longitud promedio de 18,6 DE 7,53 mm y un diámetro externo de 7 DE 1,24 mm. De las ramas del TC, la AE presentó un diámetro promedio de 5,89 DE 1,04 mm sin diferencias estadísticamente significativa con relación al diámetro de la AHC, pero si con relación al diámetro de la AGI (P= 0,70; p<0,001 respectivamente). La gran mayoría de la muestra avaluada muestra la presencia de tronco hepatoesplénico seguido de la trifurcación en una verdadera configuración de trípode. El conocimiento de los patrones de ramificación del TC debe ser tomado en cuenta por cirujanos gastroenterólogos, radiólogos intervencionistas y oncólogos para evitar complicaciones durante los procedimientos quirúrgicos abdominales.
SUMMARY: The celiac trunk (CT) is the branch of the abdominal aorta artery (AA) that provides irrigation to the distal portion of the esophagus, the middle part of the duodenum, the stomach, pancreas, spleen and additionally supplies the liver; its different anatomical expressions are reported in the different population groups with variable incidence. The morphological characteristics of the CT and its branches were evaluated in 26 blocks of the supramesocolic floor of unclaimed adult male corpses, of the mestizo population group, who were autopsied at the Institute of Legal Medicine of Bucaramanga - Colombia. Type I CT was observed in 23 specimens (88.4 %), of which 16 samples (61.5 %) corresponded. to subtype Ia with bifurcation and formation of the hepatosplenic trunk. There was one case (3.8 %) in which the branches of the CT originated independently of the AA. The CT had an average length of 18.6 SD 7.53 mm and an external diameter of 7 SD 1.24 mm. Of the CT branches, the splenic artery presented an average diameter of 5.89 SD 1.04 mm without statistically significant differences in relation to the diameter of the AHC, but if in relation to the diameter of the IGA (P = 0.70; p <0.001 respectively). The vast majority of the sample evaluated shows the presence of a hepatosplenic trunk followed by trifurcation in a true tripod configuration. Knowledge of CT branching patterns should be taken into account by gastroenterological surgeons, interventional radiologists, and oncologists to avoid complications during abdominal surgical procedures.
Subject(s)
Humans , Male , Adult , Celiac Artery/anatomy & histology , Splenic Artery/anatomy & histology , Cadaver , Cross-Sectional Studies , Colombia , Anatomic Variation , Gastric Artery/anatomy & histology , Hepatic Artery/anatomy & histologyABSTRACT
Resumen Objetivo: Reportar el caso de un aneurisma gigante de la arteria esplénica de 9,5 cm de diámetro, en una mujer de 75 años de edad, que consultó por síndrome vertiginoso, con hallazgo incidental al examen físico de masa abdominal pulsátil, confirmado mediante angiotomografía de abdomen y pelvis. Materiales y Método: Registro clínico de una paciente sometida a reparación quirúrgica abierta de una aneurisma gigante de la arteria esplénica. Resultados: Mediante laparotomía, abordaje anterior, se efectúa la ligadura del aneurisma con resección parcial del saco aneurismático más esplenectomía, evolucionando sin complicación a 12 meses de seguimiento. Discusión: Se define como aneurisma de la arteria esplénica a toda dilatación mayor a 1 cm de diámetro, presenta indicación quirúrgica cuando mide más de 2 cm y se denomina gigante a partir de los 5 cm. Conclusión: Los aneurismas de la arteria esplénica son una condición infrecuente, habitualmente asintomática, pero potencialmente mortal especialmente en embarazadas; en la literatura solo existen 78 casos reportados de aneurismas gigantes de la arteria esplénica, se recomienda la resolución quirúrgica expedita.
Aim: To report the case of a giant splenic artery aneurysm of 9.5 cm diameter, in a 75 years old woman, who consulted for vertiginous syndrome, with incidental finding to the physical examination of pulsatile abdominal mass, confirmed by angiotomography of abdomen and pelvis. Materials and Method: Clinical record of a patient undergoing open surgical repair of a giant splenic aneurysm. Results: By laparotomy, anterior approach, the ligation of the aneurysm is performed with partial resection of the aneurysm sac plus splenectomy, evolving without complication at 12 months of follow-up. Discussion: The splenic artery aneurysm, is defined at any dilatation greater than 1 cm in diameter, it is surgically indicated when they measure more than 2 cm and called giant from 5 cm. Conclusion: Splenic artery aneurysm is a uncommon condition, usually asymptomatic, but potentially fatal especially in pregnant women, in the literature there are only 78 reported cases of giant splenic artery aneurysms, expedited surgical resolution is recommended.
Subject(s)
Humans , Female , Aged , Splenic Artery/surgery , Aneurysm/surgery , Splenic Artery/diagnostic imaging , Computed Tomography Angiography , Aneurysm/diagnostic imagingABSTRACT
Thorough knowledge of splenic artery course and morphology may help clinician to provide better practice. This Study aims at finding out if there was a relationship between splenic artery tortuosity index and age, sex, Body Mass Index (BMI) and abdominal cavity diameters. Routine abdominal Computerized Tomography (CT) scan images were retrospectively analyzed for 219 patients. Splenic artery tortuosity index was calculated. Abdominal cavity diameters were measured. Age, sex, and BMI were recorded. Splenic artery straight length (x) mean was 9.41 cm (SD 1.33). Splenic artery tortuous length mean was 15.15 cm (SD 3.31). Splenic artery tortuosity index mean was 1.63 (SD 0.36). Pearson correlation coefficient for Splenic artery tortuosity index vs. age was: 0.02 (P value 0.80). Splenic artery tortuosity index for females vs. males were 1.70 vs. 1.57 (P value 0.01). Pearson correlation coefficient for Splenic artery tortuosity index vs. BMI was 0.02 (P value 0.75). Pearson correlation coefficient for Splenic artery tortuosity index vs. abdominal cavity diameters were: Anterior-Posterior (AP) diameter -0.01 (P value 0.88) and transverse diameter 0.00 (P value 0.98). There may be a relationship between splenic artery tortuosity and female sex, but not with age, BMI and abdominal cavity diameters (AP and Transverse).
El conocimiento del curso y la morfología de la arteria esplénica puede ayudar al médico a proporcionar un diagnóstico y tratamiento oportuno al paciente. Este estudio tuvo como objetivo determinar si existe una relación entre el índice de tortuosidad de la arteria esplénica y la edad, el sexo, el índice de masa corporal (IMC) y los diámetros de la cavidad abdominal. Se tomaron imágenes retrospectivas, de rutina, de 219 pacientes de tomografía computarizada (TC) abdominal. Se calculó el índice de tortuosidad de la arteria esplénica. Se midieron los diámetros de la cavidad abdominal y se registró la edad, sexo y el IMC. La media de la longitud recta de la arteria esplénica (x) fue de 9,41 cm (DE 1,33). La longitud tortuosa de la arteria esplénica fue de 15,15 cm (DE 3,31). La media del índice de tortuosidad de la arteria esplénica fue de 1,63 (DE 0,36). El coeficiente de correlación de Pearson para el índice de tortuosidad de la arteria esplénica vs. edad fue: 0,02 (valor de P 0,80). El índice de tortuosidad de la arteria esplénica para las mujeres frente a los hombres fue de 1,70 frente a 1,57 (valor de P 0,01). El coeficiente de correlación de Pearson para el índice de tortuosidad de la arteria esplénica versus el IMC fue de 0,02 (valor de P 0,75). El coeficiente de correlación de Pearson para el índice de tortuosidad de la arteria esplénica frente a los diámetros de la cavidad abdominal fue: diámetro anterior-posterior (AP) -0,01 (valor P 0,88) y diámetro transversal 0,00 (valor P 0,98). Puede existir una relación entre la tortuosidad de la arteria esplénica y el sexo femenino, sin embargo no se encontró relación con la edad, el IMC y los diámetros de la cavidad abdominal (AP y transversal).
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Splenic Artery/anatomy & histology , Tomography, X-Ray Computed , Abdomen/diagnostic imaging , Splenic Artery/abnormalities , Splenic Artery/diagnostic imaging , Body Mass Index , Sex Factors , Analysis of Variance , Age Factors , Correlation of Data , Abdomen/anatomy & histologyABSTRACT
Introduction: Spleen plays an important function in immunity and haematological functions. So, nowadays totalsplenectomy is replaced by splenic conservative surgeries. Partial removal of spleen is possible, as the spleenis divided into various segments, supplied by its own artery. The present study was undertaken to know about thesegmental branches of splenic artery.Objectives: 1.To study the number of primary segmental branches of splenic artery. 2. to measure the distancebetween the termination of splenic artery and hilum.Materials and methods: The present study was conducted on 79 adult human cadaver spleens by dissectionmethod, irrespective of their age and sex, fixed in 10% formalin solution, collected from the Department ofAnatomy and Forensic Medicine, Mysore Medical College and Research Institute, Mysore.Results: Two primary segmental branches were seen in 56 (70.9%) specimens, three primary segmental brancheswere seen in 19 (24.1%) specimens and four primary segmental branches were seen in 4 (5.1%) specimens. Themean distance between termination of splenic artery and hilum of the spleen was 2.1 cm. and the range wasextending from 0.3 cm to 6.1 cm.Conclusion: The present study adds up to the existing knowledge regarding the segmental branches of splenicartery, the better anatomical knowledge about segmental distribution of splenic artery and its variations areimportant for the partial removal of the spleen.
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Resumo Aneurismas da artéria esplênica (AAE) verdadeiros são uma patologia rara, mas potencialmente fatal. São o terceiro aneurisma abdominal mais comum, após aneurismas da aorta e da artéria ilíaca, e representam quase todos os aneurismas de artérias viscerais. Os aneurismas verdadeiros são responsáveis por 60% dos AAEs e afetam as mulheres quatro vezes mais do que os homens, geralmente relacionados a uma descoberta incidental ou sintomática aumentada que coincide com o uso da ultrassonografia na gravidez. Em pacientes grávidas, a mortalidade, após a ruptura, é de 65-75%, com mais de 90% de mortalidade fetal. Têm múltiplas etiologias, e acredita-se que as influências hormonais e as alterações do fluxo portal durante a gestação desempenhem um papel importante no desenvolvimento do AAE. Esta revisão discorrerá sobre sua história, epidemiologia, fisiopatologia, diagnóstico, e as técnicas atuais de tratamento.
Abstract True splenic artery aneurysms (SAA) are a rare, but potentially fatal, pathology. They are the third most common type of abdominal aneurysm, after aneurysms of the aorta and of the iliac artery, and account for almost the all aneurysms of visceral arteries. True aneurysms account for 60% of SAA and affect four times as many women as men, generally related to increased incidental or symptomatic findings that coincide with use of ultrasonography in pregnancy. Among pregnant patients, mortality after rupture is 65-75%, with fetal mortality exceeding 90%. There are multiple etiologies and it is believed that hormonal influences and changes in portal flow during gestation play an important role in development of SAA. This review discusses their history, epidemiology, pathophysiology, and diagnosis and current treatment techniques.
Subject(s)
Humans , Splenic Artery , Aneurysm/therapy , Endovascular Procedures , Aneurysm/diagnosis , Aneurysm/physiopathology , Aneurysm/epidemiologyABSTRACT
During routine dissection of abdomen an accessory leftgastric artery was found arising from the splenic arteryin one out of 30 adult formalin fixed cadavers in theDepartment of Anatomy, Kasturba Medical CollegeManipal. The origin of left gastric artery was normal.The accessory artery was running upwards behind usualleft gastric artery and run along lesser curvature of thestomach and also gave oesophageal branch supplyingthe lower part of esophagus. Before attempting anysurgical procedure on stomach or lower end ofoesophagus, preoperative evaluation of the arterialpattern and variations is desirable for correct surgicalapproach and to reduce postoperative complications.However, accessory left gastric origin from splenicartery becomes important to be noted when the patientundergoes angiography for diagnostic bleeding orduring trans catheter therapy. Knowledge about thesevariations is also important to be noted prior to surgeryin order to prevent postoperative complications whichwould be fatal.
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PURPOSE: This study compared the patency of the splenic vessels between laparoscopic and open spleen and splenic vessel-preserving distal pancreatectomy. METHODS: We retrospectively reviewed a database of 137 patients who underwent laparoscopic (n = 91) or open (n = 46) spleen and splenic vessel-preserving distal pancreatectomy at a single institute from 2001 through 2015. Splenic vessel patency was assessed by abdominal computed tomography and classified into three grades according to the degree of stenosis. RESULTS: The splenic artery patency rate was similar in both groups (97.8 vs. 95.7%, P = 0.779). Also, the splenic vein patency rate was not significantly different between the 2 groups (74.7% vs. 82.6%, P = 0.521). Postoperative wound complication was significantly lower in the laparoscopic group (19.8% vs. 28.3%, P = 0.006), and hospital stay was significantly shorter in the laparoscopic group (7 days vs. 9 days, P = 0.001) than in the open group. Median follow-up periods were 22 months (3.7–96.2 months) and 31.7 months (4–104 months) in the laparoscopic and open groups, respectively. CONCLUSION: Laparoscopic distal pancreatectomy showed good splenic vessel patency as well as open distal pancreatectomy. For this reason, splenic vessel patency is not an obstacle in performing laparoscopic splenic vessel-preserving distal pancreatectomy.
Subject(s)
Humans , Constriction, Pathologic , Follow-Up Studies , Laparoscopy , Length of Stay , Pancreatectomy , Retrospective Studies , Spleen , Splenic Artery , Splenic Vein , Vascular Patency , Wounds and InjuriesABSTRACT
Objective: To analyze the clinical characteristics of a patient with of Gaucher's disease with bone destruction as the main performance, and to provide the reference for its clinical diagnosis and treatment. Methods: The clinical data of a case of Gaucher's disease with bone destruction as the main performance was summarized. Combined with the related literature review, the clinical performance, complications, treatment plan, prognosis and the latest relevant research progress of the patients with Gaucher's disease were analyzed. Results: A male patient, 49 years old, was admitted to the hospital due to intermittent right thigh pain for two years, with family history of Gaucher's disease and his parents were consanguineous marriage. The patient was diagnosed as Gaucher's disease 7 years ago. Combined with the patient's history, clinical performance, family history and various auxiliary examination results, the patient was diagnosed as Gaucher's disease, right femur bone destruction, hypersplenism. The patient's right femur was extensively damaged, and the right thigh was severely painful. The patient could not afford the long-term enzyme replacement treatment and planned to have a lesion resection. Because hypersplenism and thrombocytopenia were contraindication for surgery, partial embolization of the splenic artery was performed twice (the first embolization volume was 25%, and the second embolization volume was 35%). Blood cell count was performed one week after spleen embolization, which was significantly improved: platelet count 87×109L-1, hemoglobin 91 g · L-1, and surgical treatment was planned. However, the pain was relieved and the patient gave up surgery. The patient was recommended to avoid injury, reduce weight-bearing, and prevent the pathological fractures; the patient was followed up regularly. Conclusion: The incidence of Gaucher's disease is increased in consanguineous marriage. A preliminary diagnosis was made based on the family history, clinical performance, and various auxiliary examinations, and further confirmed according to the detection of glucocerebrosidase activity. The patients with type I Gaucher's disease are eligible for enzyme replacement therapy. Without enzyme replacement therapy, the patients with chronic history will be concurrent bone destruction, hypersplenism, need symptomatic treatment such as surgery.
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BACKGROUND: Hepatocyte transplantation has achieved some success in animal experiments for the treatment of metabolic diseases and acute liver failure. However, the clinical efficacy of hepatocyte transplantation is unsatisfactory. The difference between the experimental results and the clinical efficacy may be related to the hepatocyte transplantation approach. OBJECTIVE: To evaluate the therapeutic effects of hepatocyte transplantation by the intubation via the intubation of the splenic artery and intrasplenic injection in rats with acute hepatic failure, providing more optimal transplantation approaches and methods. METHODS: Hepatocytes were isolated and cultured by the modified Seglen's method (two-step). Acute hepatic failure was induced by D-gal in Sprague-Dawley rats (provided by the Experimental Animal Center of Chongqing Medical University in China). After 24 hours, an intubation tube was inserted into the splenic artery in 65 rats with acute hepatic failure, which was successful in 60 rats. Then these 60 rat models were randomly divided into three groups (n=20 per group). Intrasplenic injection group received about 2×107 hepatocytes through intrasplenic injection and 0.4 mL of Hank's solution through the splenic artery. Splenic artery group received 0.4 mL of Hank's solution through intrasplenic injection and 2×107 hepatocytes through the splenic artery. Model group received 0.4 mL of Hank's solution through intrasplenic injection and 0.4 mL of Hank's solution through the splenic artery. Survival rate and liver function of the rats was observed within 14 days after transplantation. The distribution of CFDA-SE-labeled hepatocytes transplanted via the splenic artery was observed under fluorescence microscope at 7 days after transplantation, and meanwhile, the distribution and proliferation of transplanted hepatocytes in the spleen were observed using hematoxylin-eosin staining. Synthesis of albumin in the spleen was observed by immunofluorescence staining. RESULTS AND CONCLUSION: (1) 80％-90％ hepatocytes survived after isolation. (2) At 14 days after transplantation, the survival rates of rats in the three groups were significantly different: intrasplenic injection group> splenic artery group> model group. (3) The liver function of rats was significantly improved in the intrasplenic injection group and the splenic artery group, especially in the former group. (4) CFDA-SE-labeled hepatocytes (green fluorescence) were scattered in the rat spleen and liver at 7 days after transplantation via the splenic artery. (5) At 14 days after transplantation, immunofluorescent staining of albumin demonstrated some positive cells in the rat spleen in the intrasplenic injection group and splenic artery group. (6) At 7 days after transplantation, transplanted hepatocytes were concentrated and colonized in the red pulp of the spleen. In conclusion, hepatocyte transplantation through catheterization of the splenic artery via carotid route can improve the survival of rats with acute hepatic failure and ameliorate the hepatic function, but intrasplenic injection is significantly superior to the injection via the splenic artery.
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Introducción: la arteria esplénica es uno de los tres ramos del tronco celiaco que irriga el bazo y emite ramos al estómago y al páncreas. Objetivo: determinar las características morfológicas de la arteria esplénica. Materiales y métodos: se realizó un estudio cuantitativo, longitudinal, prospectivo, observacional y descriptivo, en 26 bloques, provenientes de cadáveres sin cirugías abdominales, ni enfermedades hematológicas, en el Hospital Provincial Universitario "Celia Sánchez Manduley", de Manzanillo, provincia Granma. Los bloques fueron lavados, fijados y disecados por el método macroscópico directo. Resultados: La arteria esplénica se originó, mayormente en el tronco celiaco (88,46 %), su trayecto fue tortuoso en el 84,62 % de los bloques relacionándose por delante de la vena esplénica (80,77 %). Los ramos colaterales fueron más frecuentes en el segmento pancrático (54,96%). Las arterias gástricas cortas fueron los ramos colaterales mayormente emitidos (100 %). La longitud media de la arteria esplénica fue de 14,7 cm y su diámetro medio es de 0,86 cm. El número de arterias terminales tuvo una media de 6,04, mientras que las arterias gástricas cortas se emitieron en una media de 4,76. Conclusiones: la arteria esplénica presenta un patrón de variabilidad anatómica bajo en cuanto a su origen y trayecto, pero sus relaciones, forma de terminación, y ramos colaterales presentan grandes variantes a la norma anatómica (AU).
Introduction: the splenic artery is one of the three of the celiac trunk that irrigates spleen and emits branches to the stomach and the pancreas. Objective: to determine the morphologic characteristics of the splenic artery. Materials and methods: a descriptive, observational, prospective, longitudinal and quantitative study was carried out in 26 tissue samples without abdominal surgeries nor hematologic diseases in the Teaching Provincial Hospital "Celia Sánchez Manduley" of Manzanillo, Granma. The samples were washed, fixed and dissected using the direct macroscopic method. Results: the splenic artery originated, mostly, in the celiac trunk (88.46 %), its itinerary was tortuous in 84.62 % of the samples, linking before the splenic vein (80.77 %). Collateral branches were more frequent in the pancreatic segment (54.96 %). Short gastric arteries were the mostly emitted collateral branches (100 %). The average longitude of the splenic artery was 14.7 cm and its average diameter 0.86 cm. The number of terminal arteries showed an average of 6.04 while the short gastric arteries were emitted in an average of 4.76. Conclusions: the splenic artery has a low anatomic variability pattern according to its origin and itinerary, but its relations, ending form and collateral branches show big variants from the anatomic norm (AU).
Subject(s)
Humans , Male , Female , Middle Aged , Spleen/anatomy & histology , Splenic Artery/anatomy & histology , Splenic Artery/abnormalities , Splenic Artery/surgery , Splenic Artery/cytology , Anatomy , Epidemiology, Descriptive , Prospective Studies , Longitudinal Studies , Observational Studies as Topic , Evaluation Studies as TopicABSTRACT
Abstract Pseudoaneurysm secondary to chronic pancreatitis is a rare complication, but one with a high mortality rate. It is etiologically associated with chronic pancreatitis, and most diagnoses are made after rupture, which manifests with clinical signs of acute hemorrhage. Computed tomography plays an important role in diagnosis, but digital subtraction angiography remains the gold-standard method for diagnostic confirmation and for treatment planning. This article describes two cases of pseudoaneurysm in patients with chronic alcoholic pancreatitis; one involving the splenic artery and the other the gastroduodenal artery, complicated by thoracic and abdominal bleeding respectively. Both were successfully treated, using minimally invasive endovascular methods to implant coils and stent-grafts.
Resumo O pseudoaneurisma decorrente de pancreatite crônica consiste em complicação rara, porém com alta taxa de mortalidade. Está etiologicamente associado à pancreatite crônica, e seu diagnóstico é feito mais comumente após ruptura, manifestando-se através de sinais clínicos de hemorragia aguda. A tomografia computadorizada desempenha papel importante no diagnóstico; contudo, a angiografia por subtração digital mantém-se como método padrão-ouro para confirmação diagnóstica e direcionamento do tratamento. O presente artigo relata dois casos de pseudoaneurisma em pacientes com pancreatite crônica alcoólica, sendo um da artéria esplênica e outro da artéria gastroduodenal, complicados com sangramento torácico e abdominal respectivamente. Ambos foram submetidos a tratamento endovascular minimamente invasivo com sucesso, através de implante de molas e de stent-grafts.