Section: Hepatobiliary Sub-section: Spleen
- Incidence
- Occur in up to 1% of population
- Account for > 60% of splanchnic aneurysms
- F > M 4:1
- Women often affected in childbearing years
- Classification
- Arterial Fibrodysplasia, Liver Transplant & Portal HTN predispose
- True aneurysm pseudoaneurysm (result from a tear in the intima) – these have a very high risk of rupture and bleeding.
- Pancreatitis & Septic Emboli predispose to false aneurysms
- Clinical
- Usually asymptomatic
- May rupture (2%) → “Abdominal Apoplexy” / haemorrhage
- May occur in pregnancy (typically 3rd trimester) → 75% maternal death rate & 90% foetal death rate
- Rupture into lesser sac – may tamponade
- Investigations
- X-ray: Concentric calcification in LUQ
- Management
- Operation for pts with:
- Symptomatic aneurysms
- Small true aneurysm < 2cm in size – can monitor
- All aneurysms in woman of child bearing age should be treated as they have a high rate of rupture in pregnancy particularly in the latter stages. Up to 100% of ruptures will result in fetal demise and there is a high rate of mortality.
-
2cm – should treat.
- Acute rupture and stable – endovascular option.
- Acute rupture and non-stable – laparotomy and splenectomy.
- Elective – embolization or aneurysm resection and bypass. Other option is splenectomy.
- Operation for pts with:
- Prognosis / Natural Hx:
- Rupture occurs in ≈ 2% but rarely with aneurysms < 2-3cm