United Health Services Port Jefferson, NY, United States
Zeinab Abdulrahman, MD1, M'hamed Turki, MD1, Hayder Azeez, MD2, Abdelhamid Ben Selma, MD1 1United Health Services, Johnson City, NY; 2Mather Hospital, Port Jefferson, NY
Introduction: True aneurysm of the splenic artery is a rare finding as it is usually asymptomatic. On extremely rare occasions, the aneurysm will present with acute abdominal pain revealing an underlying complication, rupture or thrombosis. We describe the case of a unique spontaneous ruptured splenic artery aneurysm (RSA) that presented as an acutely painful abdominal mass.
Case Description/Methods: A 77-year-old female presented with severe progressively worsening epigastric abdominal pain for two days. The pain was radiating to the left upper quadrant, exacerbated by movements, and associated with nausea.
The patient endorsed a history of postprandial nausea and early satiety for the past several months. Her past medical history includes atrial fibrillation on apixaban, hypothyroidism, hyperlipidemia, obesity, sleep apnea, diabetes mellitus, cerebrovascular accident, and depressive disorder.
At the time of presentation, she was hemodynamically stable. Physical exam was significant for left upper abdominal tenderness.
Blood work up demonstrated a white blood count of 20.4x10³/μL and hemoglobin 11 g/dl. Electrolytes were within normal limits with an INR at 1.39. Emergent CT of the abdomen without contrast, due to contrast allergy, revealed a mass in the left upper quadrant measuring 18 cm in its largest dimension (Figure1).
To better identify the nature of the mass, an abdominal MRI showed a space-occupying lesion within the retroperitoneum, between the stomach and the pancreas (Figure2).
At this point we were suspecting that this was a neoplastic process originating from the stomach; upper endoscopy with biopsy was not conclusive.
After 10 days of hospitalization, the patient became hemodynamically unstable, with blood pressure at 86/48 and heart rate at 104 bpm/min. Hemoglobin dropped from 11 g/dL to 8.4 g/dl. The patient was resuscitated with massive blood transfusion and human prothrombin complex concentrate.
A repeat CT abdomen showed increasing in the mass size measuring 20x14x11 cm (Figure3). Emergent exploratory laparotomy collected 5 L of blood clots along with 200 cc of fresh blood. The surgery disclosed an RSA, and a splenectomy was performed for hemostasis.
The patient was discharged home on the 10th postoperative day after an uneventful short ICU stay.
Discussion: RSA is rare and requires a high index of suspicion for diagnosis. In this setting and a known contrast allergy, we recommend following the hospital prophylaxis policy or performing an exploratory laparoscopy.
Figure: Figure 1: CT scan abdomen demonstrates left upper quadrant mesenteric mass measuring 18 × 11 × 8 cm concerning for possible focal hematoma Figure 2: Abdominal MRI showing space occupying lesion within retroperitoneum, between stomach and pancreas Figure 3: Repeated CT scan abdomen showing expansion of the left upper quadrant mass measuring 20 × 14 × 11 cm after 10 days from previous CT scan
Zeinab Abdulrahman indicated no relevant financial relationships.
M''hamed Turki indicated no relevant financial relationships.
Hayder Azeez indicated no relevant financial relationships.
Abdelhamid Ben Selma indicated no relevant financial relationships.
Zeinab Abdulrahman, MD1, M'hamed Turki, MD1, Hayder Azeez, MD2, Abdelhamid Ben Selma, MD1. P1571 - Spontaneous Ruptured Splenic Artery Aneurysm Presenting as an Acute Abdominal Mass, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.