Management of splenic artery aneurysm associated with extrahepatic portal vein obstruction.
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.
Department of Gastrointestinal Surgery, GB Pant Hospital, New Delhi, India.
Pramod Kumar
PK
Mishra
Sundeep Singh
SS
Saluja
Ashok K
AK
Sharma
Premanand
P
Pattnaik
D000328:Adult; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D002763:Cholecystectomy; D002768:Choledochostomy; D005260:Female; D006801:Humans; D008026:Ligation; D011169:Portal Vein; D013156:Splenectomy; D013157:Splenic Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000150:complications / Q000628:therapy*; D014656:Vascular Surgical Procedures