Xu Guang-Yan, Gong Ya-Hong, Wang Yi, Han Xian-Lin, Hao Chang, Xu Li
Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
World J Clin Oncol. 2025 Apr 24;16(4):100957. doi: 10.5306/wjco.v16.i4.100957.
Splenic artery aneurysm (SAA) rupture is a rare, life-threatening condition characterized by acute intra-abdominal hemorrhage and hemodynamic instability. Ruptured SAAs may exhibit a biphasic and relatively slow clinical progression, commonly referred to as the "double-rupture phenomenon". The reported incidence of the double-rupture phenomenon ranges 12%-21% in patients with ruptured SAAs, potentially due to variations in intra-abdominal pressure. Following anesthesia induction, muscle relaxation can decrease intra-abdominal pressure, potentially triggering the double-rupture phenomenon and leading to circulatory collapse.
A 61-year-old female presented to the Department of Emergency with upper abdominal pain, abdominal distension, dizziness, and vomiting. Her vital signs were initially stable. Physical examination revealed abdominal tenderness and positive-shifting dullness. Abdominal contrast-enhanced computed tomography revealed cirrhosis, severe portal hypertension, and splenomegaly. Acute rupture was suggested by a hematoma on the upper left side outside the SAA. Surgeons deemed intravascular intervention challenging and open splenectomy inevitable. Circulatory collapse occurred after anesthesia induction, likely due to a double rupture of the SAA. This double-rupture phenomenon may have resulted from an initial rupture of the SAA into the omental bursa, forming a hematoma that exerted a tamponade effect. A second rupture into the peritoneal cavity may have been triggered by decreased intra-abdominal pressure following anesthesia induction. The patient's life was saved through early, coordinated, multidisciplinary team collaboration. Following cardiopulmonary resuscitation and emergency splenectomy, she recovered without significant postoperative bleeding or hypoxic encephalopathy.
Anesthesia-induced pressure reduction may trigger a second SAA rupture, causing collapse. Early diagnosis and multidisciplinary teamwork improve outcomes. This is a rare and life-threatening case of SAA rupture, which is of great significance to the medical community for understanding and handling such emergencies.
脾动脉瘤（SAA）破裂是一种罕见的、危及生命的疾病，其特征为急性腹腔内出血和血流动力学不稳定。破裂的SAA可能呈现双相且相对缓慢的临床进展，通常被称为“双重破裂现象”。据报道，破裂SAA患者中双重破裂现象的发生率在12% - 21%之间，这可能是由于腹腔内压力的变化所致。麻醉诱导后，肌肉松弛可降低腹腔内压力，有可能触发双重破裂现象并导致循环衰竭。
一名61岁女性因上腹部疼痛、腹胀、头晕和呕吐就诊于急诊科。她的生命体征最初稳定。体格检查发现腹部压痛和移动性浊音阳性。腹部增强CT显示肝硬化、严重门静脉高压和脾肿大。SAA外侧左上侧的血肿提示急性破裂。外科医生认为血管内介入具有挑战性，不可避免地要进行开放性脾切除术。麻醉诱导后发生循环衰竭，可能是由于SAA的双重破裂。这种双重破裂现象可能是由于SAA最初破裂进入网膜囊，形成血肿并产生填塞效应。麻醉诱导后腹腔内压力降低可能触发了第二次破裂进入腹腔。通过早期、协调的多学科团队合作挽救了患者的生命。经过心肺复苏和急诊脾切除术后，她康复良好，术后无明显出血或缺氧性脑病。
麻醉诱导导致的压力降低可能触发SAA的第二次破裂，导致循环衰竭。早期诊断和多学科团队合作可改善治疗结果。这是一例罕见的、危及生命的SAA破裂病例，对医学界理解和处理此类紧急情况具有重要意义。
