Abstract
Relevance. Splenic artery pseudoaneurysm (SAP) is a rare pathology of great clinical significance. Splenic artery aneurysm is the third most common intraabdominal aneurysm after abdominal aortic and iliac artery aneurysms and accounts for 60-70% of all visceral aneurysms.
Although most splenic artery aneurysms are asymptomatic and are diagnosed incidentally, its rupture as its first manifestation occurs in 2-10% of cases and is a fatal complication. SAP is much less common than true aneurysm, but its prevalence among all visceral branch pseudoaneurysms reaches 27%; it develops more often in men than in women. Given its rare occurrence, which is often accompanied by various concomitant pathologies, the choice of pseudoaneurysm intervention, which is urgent in most cases, is a difficult task. Surgery has been the method of choice for many years. However, the number of endovascular interventions performed in such patients has increased over the last decade. Because SAP is a rare disease and most studies are retrospective, involving a small number of patients, there are currently no Level I evidence-based treatments. Possible causes include pancreatitis, trauma, postoperative complications and peptic ulcer. In most cases, their course is asymptomatic and they are detected incidentally by computed tomography or magnetic resonance imaging for other diseases. SAP are almost always accompanied by clinical manifestations, with abdominal pain (29.5%), hematochezia and melena (26.2%), and hematomesis (14.8%) being the most common. Secondary hemorrhage from pseudoaneurysms usually occurs in the abdominal cavity, as well as in the viment duct, adjacent organs (stomach, intestine) or in the cavity of pancreatic pseudocyst formed around a false aneurysm Rupture of pseudoaneurysms is a life-threatening condition requiring urgent surgical intervention. Besides, visceral pseudo aneurysms may be the source of recurrent gastrointestinal bleeding, and their diagnosis is a difficult task for a surgeon. Currently, both selective angiographic examination and angiography are successfully used for diagnosis. It should be noted that despite the fact that endovascular techniques are currently the "gold standard" for treatment of visceral pseudoaneurysms, there are no clear guidelines regarding treatment tactics, and the role of open surgical interventions in this pathology remains unclear, which requires further study.
Aim. Analysis of clinical and instrumental features of diagnosis of SAP. Demonstration of clinical observation of a rare source of bleeding into the gastrointestinal tract from SAP.
Materials and methods. A brief review of the literature is presented with a demonstration of our own clinical observation of a patient with recurrent gastrointestinal bleeding against SAP.
Results. Demonstration of an option for effective treatment of recurrent gastrointestinal bleeding on the background of SAP.
Conclusion. Bleeding from SAP is still a difficult clinical case in terms of diagnosis and treatment, requiring special attention and vigilance from clinicians. In case of untimely recognition, its complications may have fatal consequences.
Keywords: splenic artery pseudoaneurysm, gastrointestinal bleeding, pancreatic tumor.
Although most splenic artery aneurysms are asymptomatic and are diagnosed incidentally, its rupture as its first manifestation occurs in 2-10% of cases and is a fatal complication. SAP is much less common than true aneurysm, but its prevalence among all visceral branch pseudoaneurysms reaches 27%; it develops more often in men than in women. Given its rare occurrence, which is often accompanied by various concomitant pathologies, the choice of pseudoaneurysm intervention, which is urgent in most cases, is a difficult task. Surgery has been the method of choice for many years. However, the number of endovascular interventions performed in such patients has increased over the last decade. Because SAP is a rare disease and most studies are retrospective, involving a small number of patients, there are currently no Level I evidence-based treatments. Possible causes include pancreatitis, trauma, postoperative complications and peptic ulcer. In most cases, their course is asymptomatic and they are detected incidentally by computed tomography or magnetic resonance imaging for other diseases. SAP are almost always accompanied by clinical manifestations, with abdominal pain (29.5%), hematochezia and melena (26.2%), and hematomesis (14.8%) being the most common. Secondary hemorrhage from pseudoaneurysms usually occurs in the abdominal cavity, as well as in the viment duct, adjacent organs (stomach, intestine) or in the cavity of pancreatic pseudocyst formed around a false aneurysm Rupture of pseudoaneurysms is a life-threatening condition requiring urgent surgical intervention. Besides, visceral pseudo aneurysms may be the source of recurrent gastrointestinal bleeding, and their diagnosis is a difficult task for a surgeon. Currently, both selective angiographic examination and angiography are successfully used for diagnosis. It should be noted that despite the fact that endovascular techniques are currently the "gold standard" for treatment of visceral pseudoaneurysms, there are no clear guidelines regarding treatment tactics, and the role of open surgical interventions in this pathology remains unclear, which requires further study.
Aim. Analysis of clinical and instrumental features of diagnosis of SAP. Demonstration of clinical observation of a rare source of bleeding into the gastrointestinal tract from SAP.
Materials and methods. A brief review of the literature is presented with a demonstration of our own clinical observation of a patient with recurrent gastrointestinal bleeding against SAP.
Results. Demonstration of an option for effective treatment of recurrent gastrointestinal bleeding on the background of SAP.
Conclusion. Bleeding from SAP is still a difficult clinical case in terms of diagnosis and treatment, requiring special attention and vigilance from clinicians. In case of untimely recognition, its complications may have fatal consequences.
Keywords: splenic artery pseudoaneurysm, gastrointestinal bleeding, pancreatic tumor.
For citation:Semenkov A.V., Skugarev A.L., Setdikova G.R., Stepanova E.A., Boldyrev M.А. Pseudoaneurysm of splenic artery: literature review and clinical case. Clinical review for general practice. 2024; 5 (11): 135–141 (In Russ.). DOI: 10.47407/kr2024.5.11.00527
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