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Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
Published on: November 15, 2024
Surgical treatment of celiac-splenic aneurysms without arterial reconstruction
Masatoshi Kadoya1, Satoshi Kondo, Satoshi Hirano
1Department of Surgical Oncology, Hokkaido University Graduate School of Medicine Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan. mkado.6809@kib.biglobe.ne.jp
Insights
This study presents a rare case of multiple celiacsplenic aneurysms successfully treated with complete resection. The surgical approach avoided arterial reconstruction, offering a novel management strategy for complex vascular lesions.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Gastrointestinal Surgery
Background:
- Aneurysms of the celiac and splenic arteries are uncommon vascular conditions.
- Management typically involves resection with arterial reconstruction or endovascular repair.
- This case highlights a complex presentation requiring surgical intervention.
Observation:
- A 67-year-old male presented with sequential celiacsplenic aneurysms.
- Initial diagnosis via ultrasonography, with subsequent enlargement noted.
- Advanced imaging revealed a narrowed celiac artery with a fusiform aneurysm and two splenic artery aneurysms.
Findings:
- Surgical intervention was necessary due to the complexity and size of the aneurysms.
- En bloc resection of the pancreatic body and tail, spleen, celiac artery, and common hepatic artery was performed.
- Complete aneurysm resection was achieved without the need for arterial reconstruction.
Implications:
- This case demonstrates the feasibility of complete aneurysm resection without arterial reconstruction in complex celiacsplenic aneurysms.
- The findings suggest an alternative surgical strategy for select patients with extensive vascular involvement.
- Successful management without reconstruction may reduce operative time and potential complications.
Abstract:
We report a case of multiple sequential celiacsplenic aneurysms which we removed completely without arterial reconstruction. The patient was a 67-year-old man. During work-up for hypertension and diabetes, a splenic artery aneurysm was identified on abdominal ultrasonography. Follow-up examination 1 year and 3 months later showed enlargement of the aneurysm. The patient was referred to our Radiology Department for treatment. Abdominal computed tomography and angiography of the celiac trunk showed that the celiac artery was narrowed and then dilated to form a fusiform aneurysm. Splenic artery aneurysms were identified immediately distal to the bifurcation with the common hepatic artery, measuring about 5 cm and 3 cm. These findings ruled out treatment by interventional radiology, and surgery was performed. At laparotomy, a white, 5-cm aneurysm was densely adherent to the pancreas, and separation was impossible. We performed en bloc resection of the pancreatic body and tail, spleen, celiac artery, and common hepatic artery. Since pulsation in the replaced right hepatic artery and the color of the stomach were good, we did not perform an arterial reconstruction. Although the surgical treatment of aneurysms generally consists of resection and arterial reconstruction, we resected the lesion safely and completely without arterial reconstruction.
