CASE REPORT   

Chirurgia 2002 June;15(3):99-106

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: Italian

Splenic artery aneurysm: splenic infarction and rupture of aneurysm. Case report

Schietroma M., Carlei F., Chiominto A., Marsili L., Carloni A., Mattucci S., D’Emidio F.

Splenic artery aneurysm is a very rare condition. The most frequent complication is aneurysm rupture, while splenic infarction is the most uncommon. A case report of splenic artery aneurysm in a patient admitted with both of the above-mentioned complications and spontaneous spleen rupture is presented. C.V., male, 65 years old, who underwent cholecystectomy a year ago, and affected by atrial fibrillation, was admitted because of epigastric pain, lipothymia and fever. Epigastric pain and fever began 2 weeks before admission and regressed spontaneously. A spiral computerized tomography (CT) scan revealed a perihepatic and peripancreatic effusion extending to the right and along the left parietocolic recess. The pancreas was normal. Presence of a hypodense area on the diaphragmatic-side of the spleen (intraparenchymal hematoma?) and a left pleural effusion were noted. An accurate clinical investigation evidenced a contusive trauma at the left lower quadrant 8 months before. Serum amylase and lipase increased. Diagnosis: acute biliary pancreatitis. Conclamated shock 4 days after admission (RBC 1.76 mil/mm3, Hgb 5 g/dl). An emergency CT scan evidenced ''a perisplenic hematic effusion; a 3 cm diameter aneurysm of the splenic artery, at the splenic hilum, surrounded by hematoma''. Emergency laparotomy confirmed hemoperitoneum and hematoma of the epiploon retrocavity and showed a diaphragmatic-side splenic injury. Splenectomy and aneurysmectomy were then performed. Histology also revealed a diaphragmatic-side splenic infarctus-like injury. Microscopy confirmed splenic infarction. Arterial thrombosis at the splenic hilum was also present. The patient's postoperative recovery was regular. Persona opinion of the clinical evolution of our patient was as follows: A) epigastric pain that began 15 days before admission (with fever) was due to splenic infarction; B) symptoms referred by the patient 3 days before admission (pain, fever and lipothymia) were due to rupture of the splenic aneurysm, with formation of a retro-peritoneal hematoma. This hematoma successively spilled in the epiploon retrocavity and then in the abdominal cavity; C) symptoms that led to emergency intervention (conclamated shock) were certainly due to rupture of the splenic infarction and worsening of the hemoperitoneum.