Schatz Richard A, Schabel Stephen, Rockey Don C
Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Department of Radiology, Medical University of South Carolina, Charleston, SC, USA.
J Investig Med High Impact Case Rep. 2015 Apr 13;3(2):2324709615577816. doi: 10.1177/2324709615577816. eCollection 2015 Apr-Jun.
Splenic artery pseudoaneurysms are infrequently encountered but critical to recognize. Limited literature to date describes associations with pancreatitis, trauma, and rarely peptic ulcer disease. Hemorrhage and abdominal pain are the most common manifestations. There is typically overt gastrointestinal blood loss but bleeding can also extend into the peritoneum, retroperitoneum, adjacent organs, or even a pseudocyst. Most patients with ruptured splenic artery pseudoaneurysms present with hemodynamic instability. Here, we describe a patient recovering from acute illness in the intensive care unit but with otherwise no obvious risk factors or precipitants for visceral pseudoaneurysm. He presented with acute onset altered mental status, nausea, and worsening back and abdominal pain and was found to be in hypovolemic shock. The patient was urgently stabilized until more detailed imaging could be performed, which ultimately revealed the source of blood loss and explained his rapid decompensation. He was successfully treated with arterial coiling and embolization. Thus, we herein emphasize the importance of prompt recognition of hemorrhagic shock and of aggressive hemodynamic stabilization, as well as a focused diagnostic approach to this problem with specific treatment for splenic artery pseudoaneurysm. Finally, we recommend that multidisciplinary management should be the standard approach in all patients with splenic artery pseudoaneurysm.
脾动脉假性动脉瘤并不常见，但识别起来至关重要。迄今为止，有限的文献描述了其与胰腺炎、创伤以及罕见的消化性溃疡疾病的关联。出血和腹痛是最常见的表现。通常有明显的胃肠道失血，但出血也可蔓延至腹膜、腹膜后、邻近器官，甚至假性囊肿。大多数脾动脉假性动脉瘤破裂的患者会出现血流动力学不稳定。在此，我们描述了一名在重症监护病房从急性疾病中康复的患者，但除此之外没有明显的内脏假性动脉瘤危险因素或诱发因素。他出现急性起病的精神状态改变、恶心以及背部和腹痛加重，被发现处于低血容量性休克状态。在能够进行更详细的影像学检查之前，患者被紧急稳定病情，最终影像学检查揭示了失血来源并解释了他的迅速失代偿。他通过动脉线圈栓塞术成功得到治疗。因此，我们在此强调迅速识别出血性休克和积极进行血流动力学稳定的重要性，以及针对这个问题采用有针对性的诊断方法并对脾动脉假性动脉瘤进行特异性治疗。最后，我们建议多学科管理应成为所有脾动脉假性动脉瘤患者的标准治疗方法。
