Hamilton Emma Jane, Ngugi Samuel, Kotakadeniya Rasika
Department of General Surgery, Bundaberg Base Hospital, Bundaberg, QLD, Australia.
University of Queensland, St Lucia, QLD, Australia.
Case Rep Surg. 2023 Mar 6;2023:5738806. doi: 10.1155/2023/5738806. eCollection 2023.
A 41-year-old male presented to the emergency department of a regional Australian hospital with chest and abdominal pain. He became rapidly haemodynamically unstable and was diagnosed with a ruptured splenic artery aneurysm and large volume hemoperitoneum. Due to the regional location of our small hospital, endovascular services are not available and the patient required emergency laparotomy. At laparotomy, a 2 L hemoperitoneum was evacuated, and the bleeding splenic artery aneurysm was identified and controlled. The aneurysm was approached with a unique technique via division of the gastro colic omentum to enter the lesser sac. This allowed adequate exposure of the splenic artery and proximal and distal control of the vessel was achieved. Adequate perfusion to the spleen was preserved by this surgical technique and splenectomy was therefore not required. This study details the management of this patient, details of the interoperative technique, and a discussion regarding splenic artery aneurysms. Splenic artery control and ligation without splenectomy may be considered in appropriate patients and splenectomy is therefore not always required in cases of hemodynamic instability where open surgical management is performed.
一名41岁男性因胸痛和腹痛被送往澳大利亚一家地区医院的急诊科。他很快出现血流动力学不稳定，被诊断为脾动脉动脉瘤破裂并伴有大量腹腔积血。由于我们这家小型医院地处偏远地区，无法提供血管内治疗服务，患者需要进行急诊剖腹手术。在剖腹手术中，清除了2升腹腔积血，识别并控制了出血的脾动脉动脉瘤。通过一种独特的技术，切开胃结肠网膜进入小网膜囊来处理动脉瘤。这样可以充分暴露脾动脉，并实现对血管的近端和远端控制。通过这种手术技术保留了脾脏的充分灌注，因此无需进行脾切除术。本研究详细介绍了该患者的治疗过程、手术技术细节以及关于脾动脉动脉瘤的讨论。对于合适的患者，可以考虑在不进行脾切除术的情况下控制和结扎脾动脉，因此在进行开放手术治疗的血流动力学不稳定病例中，并非总是需要进行脾切除术。
