Surgical Management of Atraumatic Rupture of Splenic Artery Aneurysm with Spleen Preservation in a Regional Australian Hospital

Abstract

A 41-year-old male presented to the emergency department of a regional Australian hospital with chest and abdominal pain. He became rapidly haemodynamically unstable and was diagnosed with a ruptured splenic artery aneurysm and large volume hemoperitoneum. Due to the regional location of our small hospital, endovascular services are not available and the patient required emergency laparotomy. At laparotomy, a 2 L hemoperitoneum was evacuated, and the bleeding splenic artery aneurysm was identified and controlled. The aneurysm was approached with a unique technique via division of the gastro colic omentum to enter the lesser sac. This allowed adequate exposure of the splenic artery and proximal and distal control of the vessel was achieved. Adequate perfusion to the spleen was preserved by this surgical technique and splenectomy was therefore not required. This study details the management of this patient, details of the interoperative technique, and a discussion regarding splenic artery aneurysms. Splenic artery control and ligation without splenectomy may be considered in appropriate patients and splenectomy is therefore not always required in cases of hemodynamic instability where open surgical management is performed.