Re-Emergence of A Splenic Artery Pseudoaneurysm Following Rupture Presenting as Syncope: Management with Transarterial Embolization

ABSTRACT Splenic artery pseudoaneurysms are rare but potentially lethal disorder. Transarterial embolization has become the preferred mode of therapy for the disorder, however, accompanying walled-off pancreatic fluid collections including pseudocysts can make the management more challenging. Herein, we present the case of a 40-year-old woman presenting with syncope due to the rupture of a splenic artery pseudoaneurysm into a walled-off pancreatic necrotic collection. The pseudoaneurysm that re-emerged at a larger size following the rupture was endovascularly excluded from circulation after a failed attempt.

Splenik Arter Psödoanevrizmasının Senkop ile Kendini Gösteren Rüptür Sonrasında Rekürrensi: Transarteriyel Embolizasyon ile Tedavi

ÖZ Splenik arter psödoanevrizması nadir ancak potansiyel olarak ölümcül bir bozukluktur. Transarteriyel embolizasyon bu bozukluğun tedavisinde tercih edilen yöntem haline gelmiştir, ancak psödokistlerin de içerisinde yer aldığı duvarlı pankreatik sıvı birikimlerinin varlığı bu tedavi yöntemini zorlaştırabilir. Bu yazıda, splenik arter psödoanevrizmasının duvarlı bir pankreatik nekrotik sıvı birikimi içerisine yırtılmasından dolayı senkop şeklinde bulgu veren 40 yaşında kadın olguyu sunuyoruz. Yırtılmayı takiben daha büyük boyutta yeniden ortaya çıkan psödoanevrizma, başarısız bir girişimin arkasından endovasküler yöntemle dolaşımdan uzaklaştırılmıştır

___

1. Tessier DJ, Stone WM, Fowl RJ, Abbas MA, Andrews JC, Bower TC et al. Clinical features and management of splenic artery pseudoaneurysm: case series and cumulative review of literature. J Vasc Surg 2003; 38: 969-74. doi: 10.1016/S0741

2. Taslakian B, Khalife M, Faraj W, Mukherji D, Haydar A. Pancreatitis-associated pseudoaneurysm of the splenic artery presenting as lower gastrointestinal bleeding: treatment with transcatheter embolisation. BMJ Case Rep 2012; pii: bcr2012007403. doi: 10.1136/bcr-2012-007403

3. Venkatesh S, Kumar S, Baijal S, Phadke RV, Kathuria MK, Gujral RB. Endovascular management of pseudoaneurysms of the splenic artery: Experience with six patients. Aust Radiol 2005; 49: 283-8. doi: 10.1111/j.1440- 1673.2005.01466.x

4. Takahashi T, Shimada K, Kobayashi N, Kakita A. Migration of steel-wire coils into the stomach after transcatheter arterial embolization for a bleeding splenic artery pseudoaneurysm: report of a case. Surg Today 2001; 31: 458-62. doi: 10.1007/s005950170141

5. Flati G, Andrén-Sandberg A, La Pinta M, Porowska B, Carboni M. Potentially fatal bleeding in acute pancreatitis: pathophysiology, prevention, and treatment. Pancreas 2003; 26: 8-14.

6. Szpakowicz J, Szpakowicz P, Urbanik A, Markuszewski L. Splenic artery pseudoaneurysm rupture into a pancreatic pseudocyst with its subsequent perforation as the cause of a massive intra-abdominal bleeding - case report. Pol J Surg 2016; 88: 350-5. doi: 10.1515/pjs-2016-0075

7. Mavrodin CI, Pariza G, Iordache V, Pop CS. Massive upper gastrointestinal bleeding - complication of pancreatic pseudocyst. J Med Life 2014; 7: 202-4.

8. Lo WL, Mok KL. Ruptured splenic artery aneurysm detected by emergency ultrasound - a case report. Crit Ultrasound 2015; 7: 9. doi: 10.1186/s13089-015-0026-4

9. Lakin RO, Bena JF, Sarac TP, Shah S, Krajewski LP, Srivastava SD et al. The contemporary management of splenic artery aneurysms. J Vasc Surg 2011; 53: 958-65. doi: 10.1016/j.jvs.2010.10.055

10. Al-Habbal Y, Cristophi C, Muralidharan V. Aneurysms of the splenic artery - a review. Surgion 2010; 8: 223-31. doi: 10.1016/j.surge.2009.11.011