Tani Ryotaro, Hori Tomohide, Yamamoto Hidekazu, Harada Hideki, Yamamoto Michihiro, Yamada Masahiro, Yazawa Takefumi, Tani Masaki, Kamada Yasuyuki, Aoyama Ryuhei, Sasaki Yudai, Zaima Masazumi
Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan.
Department of Surgery, Shiga General Hospital, Moriyama, Japan.
Am J Case Rep. 2019 Apr 29;20:620-627. doi: 10.12659/AJCR.915010.
BACKGROUND Visceral arterial aneurysms are rare. Most splenic arterial aneurysms (SAAs) are saccular and are in the distal third of the splenic artery. Suggested major causes of SAAs are atherosclerosis, pregnancy, and inflammation. We report the case of a patient who with a SAA extending almost the full length of his splenic artery. CASE REPORT A solitary true aneurysm that extended almost the entire length of the splenic artery was incidentally detected in an asymptomatic 70-year-old male patient with a history of myasthenia gravis and diabetes mellitus. His SAA was severely calcified, but other arteries showed no calcification. The aneurysm had been slightly enlarged toward the celiac artery for 2 years, and aneurysmectomy and splenectomy were performed. Vascular clips were carefully placed at the intact splenic artery without disturbing arterial flows from the celiac artery. Arterial branch from the SAA was ligated at an intact area, and the pancreatic capsule was densely adherent with the calcified aneurysm wall. The pancreas was preserved, although the pancreatic parenchyma was widely exposed during aneurysmectomy. Pathological examination revealed no atherosclerotic changes. Postoperatively, a pancreatic fistula developed, which was treated by placing an intraperitoneal drain and retrograde pancreatic drainage tube. Nevertheless, the intractable pancreatic fistula triggered a bacteriogenic infection, resulting in intraperitoneal abscess. Continuous local lavage via transnasal continuous infusion and endoscopic transgastric drainage was performed, until the fistula closed. He was healthy at 9 months after surgery. CONCLUSIONS A SAA that had the rare form and solitary origin was treated. Continuous local lavage has a therapeutic potential for a pancreatic juice-related bacteriogenic complication.
背景 内脏动脉瘤较为罕见。大多数脾动脉瘤（SAA）为囊状，位于脾动脉的远侧三分之一处。SAA的主要病因被认为是动脉粥样硬化、妊娠和炎症。我们报告了一例SAA几乎累及脾动脉全长的患者病例。病例报告 在一名有重症肌无力和糖尿病病史的70岁无症状男性患者中偶然发现了一个孤立的真性动脉瘤，该动脉瘤几乎累及脾动脉的整个长度。他的SAA严重钙化，但其他动脉未显示钙化。该动脉瘤向腹腔动脉方向略有增大已2年，遂行动脉瘤切除术和脾切除术。在完整的脾动脉处小心放置血管夹，同时不干扰来自腹腔动脉的血流。在完整区域结扎SAA的动脉分支，胰腺包膜与钙化的动脉瘤壁紧密粘连。尽管在动脉瘤切除术中胰腺实质广泛暴露，但仍保留了胰腺。病理检查未发现动脉粥样硬化改变。术后发生了胰瘘，通过放置腹腔引流管和逆行胰引流管进行治疗。然而，难治性胰瘘引发了细菌性感染，导致腹腔脓肿。通过经鼻持续输注和内镜经胃引流进行持续局部灌洗，直至瘘口闭合。术后9个月他恢复健康。结论 治疗了一例具有罕见形态和孤立起源的SAA。持续局部灌洗对与胰液相关的细菌性并发症具有治疗潜力。
