27 YEARS OLD MALE WITH RUPTURED ANEURYSM SPLENIC ARTERY

Abstract

Introduction: Aneurysms of the splenic artery are the third most common type of aneurysm, but their prevalence is still low.  The splenic artery is the most frequent site of visceral arterial aneurysms. Usually a splenic artery aneurysm occurs as a single event; rupture is frequent, sometimes occurring as the first symptom and is sometimes fatal. The spleen has a dual blood supply (ie, SA and short gastric arteries), so embolization procedures do not threaten the vascular integrity of the spleen.

Case Presentation: A 27-year-old man presented at Saiful Anwar Hospital with chief complaint chief complaint upper left abdominal pain for about one week, persistent pain and has not diminished since the beginning. At the beginning, the pain felt at the upper left and then radiating to the epigastrium, it felt like a stabbing pain. About one week ago, epigastrium mass has started, enlarging quickly but there was no pain. There are no nausea and vomiting complaints.  There are decreased appetite and decreased body weight. Patient is in a Tuberculosis treatment for one month. No defecation complaint and no trauma to the abdomen.

Discussion: Aneurysmectomy with proximal and distal ligation can be performed, with or without reconstruction of the artery after removal of the aneurysm. In some cases splenectomy, pancreatectomy or both may be necessary. Indications are splenic devascularization, caused by ligature of the artery, or aneurysmal adhesion to the pancreas. The alternative is to employ endovascular embolization, which offers the advantage of low invasivity and is of great help when patients exhibit high surgical risk. Nevertheless, one should be conscious of the possibility of complications, such as coil migration, occlusion of the incorrect branch, splenic infraction and infection,12 in addition to the need for an agile and experienced surgical team and the necessary materials always at hand, particularly for emergency situations.

Conclusion: Splenic artery aneurysms are often asymptomatic and rare and therefore difficult to diagnose. When a patient presents with left upper quadrant or epigastric abdominal pain and signs of haemorrhage or shock, SAA should be considered. Embolisation is the first line of treatment. Recanalization with haemorrhagic shock can occur, particularly after an incomplete embolisation. Therefore, a close monitoring after embolisation is needed. If rebleeding is probable, open surgery can be lifesaving.