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伪装成上消化道出血的脾动脉瘤:一例罕见病例报告。

Splenic artery aneurysm masquerading as upper gastrointestinal bleeding: A rare case report.

作者信息

Budha Bishal, Neupane Narayan Prasad, Joshi Bishweshwar, Poudel Dhiraj, Pandey Arjun, Budha Rajan

机构信息

Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, Nepal.

Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, Nepal.

出版信息

Int J Surg Case Rep. 2025 Feb;127:110894. doi: 10.1016/j.ijscr.2025.110894. Epub 2025 Jan 15.

Abstract

INTRODUCTION AND IMPORTANCE

Splenic artery aneurysm is extremely rare but potentially life threatening disease which poses great challenge in diagnosing due to non-specific nature of clinical presentation. Rarely, it presents with upper gastrointestinal bleeding i.e. hematemesis and melena.

CASE PRESENTATION

A 58-years-old male presented with three and half month history of black tarry stool and abdominal pain, who was initially diagnosed as erosive gastritis and managed with antacids and PPI. After few months of resolution of symptoms, he experienced light-headedness, severe epigastric pain and syncopal episodes. That led to further imaging study which revealed splenic artery aneurysm with celiac artery dissection for which he underwent splenectomy after failure two repeat embolization intervention. Postoperative recovery was smooth, and he remained asymptomatic on follow-up.

CLINICAL DISCUSSION

Though, there is constant risk of SAA to rupture, in our case pressure exerted by aneurysm on celiac artery caused dissection and upper GI bleeding. Endovascular technique is preferred technique but surgery reserved as options in case of failure.

CONCLUSION

This case highlights the complexities in diagnosing and treating life threating splenic artery aneurysm with celiac artery dissection.

摘要

引言与重要性

脾动脉瘤极为罕见,但却是一种潜在的危及生命的疾病,因其临床表现缺乏特异性,在诊断方面极具挑战性。极少情况下,它会以上消化道出血的形式出现,即呕血和黑便。

病例介绍

一名58岁男性,有三个半月的黑便和腹痛病史,最初被诊断为糜烂性胃炎,并接受了抗酸剂和质子泵抑制剂治疗。症状缓解数月后,他出现头晕、严重上腹痛和晕厥发作。这促使进一步的影像学检查,结果显示为脾动脉瘤合并腹腔干动脉夹层,在两次重复栓塞干预失败后,他接受了脾切除术。术后恢复顺利,随访期间无症状。

临床讨论

尽管脾动脉瘤始终存在破裂风险,但在我们的病例中,动脉瘤对腹腔干动脉施加的压力导致了夹层形成和上消化道出血。血管内技术是首选技术,但在失败的情况下,手术作为备选方案。

结论

本病例突出了诊断和治疗伴有腹腔干动脉夹层的危及生命的脾动脉瘤的复杂性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/722a/11786642/2981498b95db/gr1.jpg

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