Management of splenic artery aneurysm associated with extrahepatic portal vein obstruction

BACKGROUND: Splenic artery aneurysms although rare are clinically significant in view of their propensity for spontaneous rupture and life-threatening bleeding. While portal hypertension is an important etiological factor, the majority of reported cases are secondary to cirrhosis of the liver. We re...

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Bibliographic Details
Published in:Hepatobiliary & pancreatic diseases international 2012-06, Vol.11 (3), p.330-333
Main Authors: Mishra, Pramod Kumar, Saluja, Sundeep Singh, Sharma, Ashok K, Pattnaik, Premanand
Format: Article
Language:English
Subjects:
Adult
aneurysm
Aneurysm - diagnostic imaging
Aneurysm - etiology
Aneurysm - surgery
artery
Cholecystectomy
Choledochostomy
Endocrinology & Metabolism
extrahepatic
extrahepatic portal vein obstruction
Female
Gastroenterology and Hepatology
Humans
hypertension
Ligation
obstruction
portal
portal hypertension
Portal Vein
proximal
proximal splenorenal shunt
shunt
Splenectomy
splenic
Splenic Artery - diagnostic imaging
Splenic Artery - surgery
splenic artery aneurysm
splenorenal
Tomography, X-Ray Computed
Treatment Outcome
Vascular Diseases - complications
Vascular Diseases - therapy
Vascular Surgical Procedures
vein
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Summary:BACKGROUND: Splenic artery aneurysms although rare are clinically significant in view of their propensity for spontaneous rupture and life-threatening bleeding. While portal hypertension is an important etiological factor, the majority of reported cases are secondary to cirrhosis of the liver. We report three cases of splenic artery aneurysms associated with extrahepatic portal vein obstruction and discuss their management. METHODS: The records of three patients of splenic artery aneurysm associated with extrahepatic portal vein obstruction managed from 2003 to 2010 were reviewed retrospectively. The clinical presentation, surgical treatment and outcome were analyzed. RESULTS: The aneurysm was >3 cm in all patients. The clinical symptoms were secondary to extrahepatic portal vein obstruction (hematemesis in two, portal biliopathy in two) while the aneurysm was asymptomatic. Doppler ultrasound demonstrated aneurysms in all patients. A proximal splenorenal shunt was performed in two patients with excision of the aneurysm in one patient and ligation of the aneurysm in another one. The third patient had the splenic vein replaced by collaterals and hence underwent splenectomy with aneurysmectomy. All patients had an uneventful post-operative course. CONCLUSIONS: Splenic artery aneurysms are associated with extrahepatic portal vein obstruction. Surgery is the mainstay of treatment. Although technically difficult, it can be safely performed in an experienced center with minimal morbidity and good outcome.
ISSN:1499-3872
DOI:10.1016/S1499-3872(12)60170-2