Splenic artery aneurysm: What you need to know

The article is professionally consulted by Master, Doctor Vu Van Quan - Gastroenterologist - Department of General Surgery & Anesthesiology - Vinmec Hai Phong International General Hospital

Splenic artery aneurysm is a rare clinical condition, often discovered incidentally on abdominal imaging or on autopsy with other causes. The average incidence of splenic artery aneurysms is about 0.1%, can occur at any age, and is common in people over 50 years of age. Women are more likely to have splenic artery aneurysms than men, especially in the second half of pregnancy.
Scary and common complication of splenic artery aneurysm is rupture of aneurysm, causing massive intra-abdominal bleeding, causing the patient to fall into a state of blood loss shock. Rupture of splenic artery aneurysms accounts for about 3% to 10%. A few cases of ruptured splenic artery aneurysms have been reported in pregnant women with maternal mortality rates above 80%. Pregnant women with splenic artery aneurysms may also experience complications of aneurysm rupture after pregnancy. Hypertension is a favorable factor, increasing the rate of rupture of splenic artery aneurysms.

Splenic artery aneurysms can arise from a variety of causes, although the specific mechanism is not well understood. Abnormal conditions that cause splenic aneurysm can be listed as follows:
Congenital vascular malformations Splenic artery embolism Splenic artery thrombosis Atherosclerotic vascular pregnancy Pregnancy portal hypertension Pancreatitis Chronic Certain toxins cause damage to the vessel wall. Causes of splenic artery aneurysms are varied but not always found. Patients with splenic aneurysms should be prioritized for prompt identification and management rather than finding the cause.

Uncomplicated splenic artery aneurysms are usually asymptomatic. The patient lived peacefully with the aneurysm without any problems. If the splenic artery aneurysm is too large, the patient may feel a dull ache in the abdomen.

Rupture of aneurysm usually occurs suddenly. The prominent manifestation of aneurysm rupture is sudden, severe abdominal pain. If not detected and treated promptly, the patient will fall into shock due to excessive blood loss. Cold, wet extremities, altered mental status, and changes in blood pressure are suggestive of shock. Examination of the patient can detect low-grade percussion, abdominal wall reaction. In some cases, rupture of splenic artery aneurysms has caused bleeding into internal abdominal organs such as pancreas, stomach and colon.

Diagnosis of splenic artery aneurysm is determined by imaging modalities. Images of splenic artery aneurysms were observed, assessing the shape of the splenic artery, the size, location of the aneurysm and the degree of compression of the adjacent organs. When the splenic artery aneurysm ruptures, intraperitoneal hemorrhage is also identified by imaging techniques.
Abdominal ultrasound and abdominal computed tomography are the two most commonly used clinical imaging methods to diagnose splenic artery aneurysms. Often, a patient presents to a doctor for another medical condition and is discovered incidentally a splenic artery aneurysm. Imaging tests can also detect some causes of aneurysms. Some common tests to assess the degree of blood loss and accompanying complications are also indicated such as complete blood count, blood group test, basic hemostatic function, blood urea and creatinine ...

Splenic artery aneurysm rupture is a life-threatening emergency, so the treatment of ruptured splenic artery aneurysm requires the coordination of many specialties. The main treatment goals include circulatory resuscitation, blood loss compensation in conjunction with resolution of the aneurysm occlusion. Patients are given fluids, blood transfusions, oxygen, and basic vital functions. In the past, surgery was the mainstay of treatment for splenic aneurysms and its complications. However, the success rate of this method is not high, more than 50% of patients die with the main cause being heavy blood loss.
With the development of science and technology in medicine, today patients with aneurysms can be treated with vascular interventions, which are performed under the guidance of a bright screen. This is a minimally invasive method, performed quickly, so it is effective in cases of acute aneurysm rupture with a higher success rate. Aneurysmectomy was chosen when vascular interventions failed, and the patient continued to bleed with no improvement in clinical symptoms. Splenectomy may be performed concurrently during surgery if splenic rupture is present. In addition, surgery has been shown to be more effective in severe cases such as splenic artery aneurysms bursting into other organs.