Successful management of eleven splanchnic artery aneurysms.

OBJECTIVE

To describe our experience with the management of aneurysms of the splanchnic arteries.

DESIGN

Retrospective study.

SETTING

Teaching hospital, Norway.

SUBJECTS: Eleven consecutive patients with aneurysms of the splanchnic arteries treated between 1986 and 1996, six of them between 1994 and 1996. Four aneurysms were hepatic (37%), two splenic (18%), one coeliac (9%), one gastroepiploic (9%), one pancreaticoduodenal (9%), one superior mesenteric (9%), and one jejunal (9%). Five were pseudoaneurysms (46%).

INTERVENTIONS: Six patients (55%) were treated by operation, four (36%) by embolisation and one (9%) expectantly.

RESULTS

The pathogenesis was inflammatory (acute pancreatitis, anastomotic leak) in four patients (36%), athero-sclerotic in three (27%), arterial infusion of cytotoxic drugs in one (9%), and unknown in four (36%). Seven patients (64%) presented with rupture, two (18%) with other symptoms, and two patients (18%) were diagnosed incidentally. There was no mortality.

CONCLUSION

There may be an increased incidence in splanchnic artery aneurysms, particularly those created by inflammatory lesions. The diagnosis should be suspected if acute bleeding occurs during the course of severe intra-abdominal inflammation. Arteriography should be used to diagnose an aneurysm in haemodynamically stable patients. Control of bleeding is obtained either by transarterial catheter embolisation or by operation.