Journal of Emergencies, Trauma, and Shock
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LETTER TO EDITOR  
Year : 2016  |  Volume : 9  |  Issue : 1  |  Page : 38-39
Successful resuscitation after splenic artery aneurysm rupture


Department of Emergency Medicine, Cantonal Hospital of St. Gallen, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland

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Date of Web Publication13-Jan-2016
 

How to cite this article:
Frasnelli A. Successful resuscitation after splenic artery aneurysm rupture. J Emerg Trauma Shock 2016;9:38-9

How to cite this URL:
Frasnelli A. Successful resuscitation after splenic artery aneurysm rupture. J Emerg Trauma Shock [serial online] 2016 [cited 2020 Jan 17];9:38-9. Available from: http://www.onlinejets.org/text.asp?2016/9/1/38/173863


Sir,

Massive hematemesis with hemorrhagic shock without trauma and subsequent cardiac arrest is a clear life-threatening situation. Intragastric rupture of an aneurysm of the splenic artery is a rare but important differential diagnosis and urgent diagnosis, usually by computed tomography (CT), and rapid treatment, usually open surgery, are necessary.

A 48-year-old man was brought to our emergency department after he started vomiting blood and collapsed at the nearby main railway station. Despite prompt crystalloid and colloid fluid infusions, the patient's condition deteriorated as vomiting of fresh blood persisted. Soon after arrival at our shock room, the patient suffered cardiac arrest and cardiopulmonary resuscitation was started and treatment with packed red blood cells, crystalloid and colloid fluids, fresh frozen plasma, tranexamic acid and blood coagulation factors was begun.

After stabilization of the patient's condition with a palpable femoral pulse and intubation, emergency gastroscopy was performed in the resuscitation area. A diagnosis of bleeding esophageal varices was suspected because a history of alcohol abuse was suspected without identification of the source of bleeding. An intragastric rupture of a splenic artery aneurysm (SAA) was identified at CT [Figure 1]. The patient was transferred to the department of interventional radiology for endovascular occlusion of the aneurysm with front and back door coil embolization of the splenic artery [Figure 2] and the aneurysm. The patient returned home 19 days after successful resuscitation.
Figure 1: Ruptured aneurysm (A) of the splenic artery; (B) the stomach (C) is filled with fresh blood

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Figure 2: Coils in the splenic artery and the calcified splenic artery aneurysm

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Splenic artery aneurysms are very rare with an incidence of approximately 0.8%[1] and are the third most common abdominal artery aneurysms after aortic and iliac artery aneurysms.[2] Rupture of an SAA has often fatal consequences, with mortality rates of up to 29%[3] and even higher in pregnant women (75%),[4] who are the most frequently affected. A ruptured SAA must be managed with immediate surgical or endovascular treatment. Our case is the first reporting on a ruptured idiopathic SAA managed by an endovascular procedure alone.[5]

A ruptured SAA is associated with high mortality and must be rapidly diagnosed and treated. Endovascular intervention and coil embolization appear to be a feasible treatment and a reasonable alternative to surgery for the management of massive bleeding caused by a ruptured SAA.


   Acknowledgments Top


I would like to thank Sebastian Leschka for the illustrations and Alistair Reeves for editing the text.

 
   References Top

1.
Berceli SA. Hepatic and splenic artery aneurysms. Semin Vasc Surg 2005;18:196-201.  Back to cited text no. 1
    
2.
Grotemeyer D, Duran M, Park EJ, Hoffmann N, Blondin D, Iskandar F, et al. Visceral artery aneurysms – follow-up of 23 patients with 31 aneurysms after surgical or interventional therapy. Langenbecks Arch Surg 2009;394:1093-100.  Back to cited text no. 2
    
3.
Lauschke H, Rudolph J, Textor J, Strunk H, Remig J. Visceral artery aneurysms. Zentralbl Chir 2002;127:538-42.  Back to cited text no. 3
    
4.
Pasha SF, Gloviczki P, Stanson AW, Kamath PS. Splanchnic artery aneurysms. Mayo Clin Proc 2007;82:472-9.  Back to cited text no. 4
    
5.
Abdulrahman A, Shabkah A, Hassanain M, Aljiffry M. Ruptured spontaneous splenic artery aneurysm: A case report and review of the literature. Int J Surg Case Rep 2014; 5:754-7.  Back to cited text no. 5
    

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Correspondence Address:
Andreas Frasnelli
Department of Emergency Medicine, Cantonal Hospital of St. Gallen, Rorschacher Strasse 95, 9007 St. Gallen
Switzerland
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.173863

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  [Figure 1], [Figure 2]



 

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