Splenic Artery Aneurysm

Han, Wonshik; Jung, In Mok; Yun, Ik Jin; Cho, Byung Sun; Ha, Jongwon; Kim, Sang Joon

Abstract

Splenic artery aneurysms (SAA) are the third most common intra-abdominal aneurysm and most common splanchnic artery aneurysm. They remain the subject of continued interest since the first case reported by Beaussier in 1770. The cause and indications for surgical treatment are controversial. In most cases, SAAs are detected as incidental findings. Their importance lies in their potentially fatal consequence due to rupture. We reviewed clinical features and treatment results of patients with splenic artery aneurysm experienced in Seoul National University Hospital from January, 1987 to June, 1997. Six patients of SAAs were treated during this period. Male to female ratio was 3:3, and median age was 56 years. The mean parity of all women was 3.7 and there were no pregnant women. Common symptoms were abdominal pain, hematemesis, and abdominal mass. Two patients(33.3%) were asymptomatic. The associated diseases that might cause the aneurysms were pancreatitis in 2 patients, portal hypertension in 1, operative trauma in 1, and mycotic aneurysm in 1 patient. Rupture occurred in 2 patients. One patients presented repeated hematemesis due to formation of gastro-aneurysmal fistula. Except one patient diagnosed as SAA incidentally during gastrectomy, all aneurysms were confirmed by angiography. Abdominal sonography was performed in 4 patients, and CT scan in 3. The size of the aneurysms ranged from 1 cm to 8 cm in diameter, with larger than 3 cm in 66%, smaller than 2 cm in 33% of aneurysms. About location, 33% located at proximal vessels, 17% at mid-third and 50% at distal. Five patients underwent surgical treatment. Splenectomy was performed in 3 patients, and exclusion of aneurysm in 2. We could preserve spleen in 1 case of distally located aneurysm by aneurysmal exclusion and end-to-end anastomosis of splenic artery. One patient underwent percutaneous embolization of the lesion and successfully treated. Two postoperative complications developed in ruptured cases and were managed conservatively. There was no postoperative mortality. In conclusion, complication and mortality in elective operation of SAA decreased due to recent improvement of radiologic tools and operative techniques. Considering severe fatality and morbidity of rupture of aneurysm, prompt and aggressive treatment is required in patients with high risk of rupture.