Management of splenic artery aneurysm associated with extrahepatic portal vein obstruction

作     者：Pramod Kumar Mishra Sundeep Singh Saluja Ashok K Sharma Premanand Pattnaik 

作者机构：Department of Gastrointestinal Surgery Surgery GB Pant Hospital Department of Gastrointestinal Surgery and Department of Radiology Surgery GB Pant Hospital Department of Gastrointestinal Surgery GB Pant Hospital 

出 版 物：《Hepatobiliary & Pancreatic Diseases International》 (国际肝胆胰疾病杂志（英文版）)

年 卷 期：2012年第11卷第3期

页      面：330-333页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

主　　题：splenic artery aneurysm extrahepatic portal vein obstruction portal hypertension proximal splenorenal shunt 

摘      要：BACKGROUND: Splenic artery aneurysms although rare are clinically significant in view of their propensity for spontaneous rupture and life-threatening bleeding. While portal hypertension is an important etiological factor, the majority of reported cases are secondary to cirrhosis of the liver. We report three cases of splenic artery aneurysms associated with extrahepatic portal vein obstruction and discuss their management. METHODS: The records of three patients of splenic artery aneurysm associated with extrahepatic portal vein obstruction managed from 2003 to 2010 were reviewed retrospectively. The clinical presentation, surgical treatment and outcome were analyzed. RESULTS: The aneurysm was 3 cm in all patients. The clinical symptoms were secondary to extrahepatic portal vein obstruction (hematemesis in two, portal biliopathy in two) while the aneurysm was asymptomatic. Doppler ultrasound demonstrated aneurysms in all patients. A proximal splenorenal shunt was performed in two patients with excision of the aneurysm in one patient and ligation of the aneurysm in another one. The third patient had the splenic vein replaced by collaterals and hence underwent splenectomy with aneurysmectomy. All patients had an uneventful post-operative course. CONCLUSIONS: Splenic artery aneurysms are associated with extrahepatic portal vein obstruction. Surgery is the mainstay of treatment. Although technically difficult, it can be safely performed in an experienced center with minimal morbidity and good outcome.