Ruptured jejunal artery aneurysm

Visceral artery aneurysms (VAAs), unlike aortic aneurysms, are very rare, but are also a potentially lethal vascular disease. Jejunal artery aneurysms only account for less than 3% of VAAs, but have a 30% risk of rupture, with 20% death rate, presenting with only few and vague symptoms. We report the case of a 76-year-old man presenting at the emergency department (ED) with a crampy epigastric pain and vomiting. An ultrasound performed diagnosed free abdominal fluid and immediate CT scan diagnosed jejunal artery aneurysm spontaneously rupturing, followed by hypovolaemic shock. Emergent surgery was undertaken, and aneurysmectomy, followed by partial enterectomy with primary anastomosis were performed, because of segmentary jejunal ischaemia. The patient's recovery was unremarkable. High level of suspicion, rapid diagnosis capability and prompt surgical or endovascular intervention, as well as an effective teamwork in the ED are critical to avoid the devastating consequences of ruptured VAAs.

Journal of Vascular Surgery, 2001

Medicina

Background and Objectives: Jejunal artery (JA) and ileal artery (IA) aneurysms constitute less than 3% of all visceral artery aneurysms (VAAs), carrying a risk of rupture as high as 30%, and a mortality of 20%. Though many etiologies have been reported in the literature, no mention exists on a causal association between these aneurysms and inflammatory bowel diseases (IBD). We present the first case of a JA aneurysm related to Crohn’s Disease (CD) together with a review of the literature. Materials and Methods: A 74-year-old male presenting with CD intestinal relapse and an incidental finding at the computed tomography enterography (CTE) of a 53 × 47 × 25mm apparently intact JA pseudoaneurysm, arising from the first and second jejunal branches, underwent coil embolization followed by small bowel resection, with an uneventful outcome. We also included the review of literature on JA and IA aneurysms, analyzing all reports published in PubMed and Scopus from 1943 to July 2022. Results:...

CORREÇÃO DE ANEURISMA ABDOMINAL ROTO: RELATO DE CASO (Atena Editora), 2021

This report addresses the case of a 65-year-old man, who presented with abdominal pain, sweating and hypotension for 3 days and who, when looking for an emergency room, was diagnosed with a ruptured abdominal aortic aneurysm (AAAr), of the juxtarrenal type in anterior wall. He was referred and underwent emergency surgery for transperitoneal access repair. Abdominal aortic aneurysm (AAA) results from endothelial weakness that precedes the abnormal dilation of more than 50% of the arterial wall. AAAr is a surgical emergency, with a mortality rate of 80% to 90% of cases. About a third of patients die before reaching the hospital and only 50% of patients undergoing surgical repair survive the perioperative period. Tears can occur in the posterior, lateral or anterior wall of the abdominal aorta. Those on the posterior or lateral wall are tamponade by compression by adjacent structures, a fact that makes surgical correction feasible as the patient maintains hemodynamic stability. Anterior wall ruptures tend to progress with massive hemorrhages into the peritoneal cavity, as they do not progress with immediate packing, increasing the mortality rate in these cases. The relevance of this case lies in the rare clinical presentation of a pathology with high mortality in which there was tamponade of the anterior rupture by external factors, which enabled surgical correction. Mastering the different clinical presentations of this pathology is important for timely diagnosis and treatment, which has a positive impact on the morbidity and mortality of ruptured abdominal aortic aneurysms.

Annales de Chirurgie Vasculaire, 2011

Un homme de 66 ans avec des comorbidit es multiples s'est pr esent e avec un an evrysme aortique p eri-anastomotique juxta-r enal 10 ans apr es une r eparation abdominale ouverte d'un an evrysme aortique. La maladie an evrismale atteignait egalement les deux bifurcations iliaques, l'art ere iliaque interne droite, l'art ere f emorale commune gauche (CFA) jusqu' a sa bifurcation, et l'art ere poplit ee homolat erale. Nous avons fait une embolisation bilat erale de l'art ere iliaque interne par spires a un mois d'intervalle. Par la suite, nous avons plac e un stentgraft aortouniiliaque s' etendant a l'art ere iliaque externe droite avec mise en place d'un bouchon endovasculaire dans l'art ere iliaque externe gauche. Un pontage de la CFA droite a la bifurcation f emorale gauche etait alors cr e e apr es ligature de l'an evrysme de la CFA gauche. Apr es la r ecup eration de l'anesth esie et en d epit de l'embolisation hypogastrique s equentielle, le patient a d evelopp e une parapl egie postop eratoire, une isch emie de fesse, et une colite isch emique et est mort a J 5. Les m ecanismes pathog enes possiblement impliqu es dans la survenue de ces complications isch emiques sont discut es dans cet article.

Annals of Vascular Surgery, 2004

Visceral artery aneurysms (VAA) can be treated by revascularization, ligation, or, most often, endovascular techniques depending on clinical presentation, hemodynamic status, and location. From 1975 to 2002 a total of 42 VAA in 34 patients were treated. The lesion involved the splenic artery (SA; 19), pancreaticoduodenal artery (PDA; 6), celiac trunk (CT; 5), superior mesenteric artery (SNA; 4), common hepatic artery (CHA; 3), gastroduodenal artery (GDA; 2), left hepatic artery (LHA; 1), a branch of the inferior mesenteric artery (BIMA; 1), and a branch of the SMA (BSMA; 1). Twenty-seven VAA in 21 patients (64%) were uncomplicated (group I) and 15 VAA in 13 patients (36%) had ruptured (group II) (PDA; 6; CT, 3; SA, 1; CHA, 1; LHA, 1; BSMA, 1; BIMA, 1). In group I VAA were treated by embolization (n = 11), splenectomy (n = 6), bypass (n = 7), ligation (n = 2), and aneurysmorraphy (n = 1). No deaths were observed. The morbidity rate associated with surgical treatment was 12% including hepatic bypass thrombosis without ischemic complications in two cases. The morbidity rate associated with endovascular treatment was 18% including cholecystitis in one case and bile duct stenosis in one case. The VAA recanalization rate following embolization was 9%. In group II, 12 VAA (80%) were treated by ligation in association with splenectomy in two cases and left hepatectomy in one case. Only one bypass procedure was performed and embolization was used to treat two VAA (1 SMA and 1 PDA). The mortality rate was 20% (3/15). The morbidity rate associated with surgical treatment was 46% (6/13) including bile duct stenosis in one case, ischemic cholecystitis in one case, duodenal fistula in one case, pancreatic fistula in one case, bile tract fistula in one case, and colonic ischemia in one case. No patient died after endovascular treatment and the morbidity rate was 50% (1/2) with duodenal stenosis occurring in one case. In sum, VAA can rupture. Emergency cases can be treated by ligation in most cases or by embolization if the hemodynamic status of the patient allows. Regardless of treatment technique, the morbidity and mortality rate remains high after rupture, especially in cases involving PDA. Embolization can be proposed as a first-line treatment for most VAA. Because of the risk of rupture, endovascular or open repair is warranted for VAA and has a favorable prognosis.

Journal of Ultrasonography, 2018

Although visceral artery aneurysms are rare, mortality due to their rupture is high, estimated at even 25-75%. That is why it is significant to detect each such lesion. Visceral artery aneurysms are usually asymptomatic and found incidentally during examinations performed for other indications. Autopsy results suggest that most asymptomatic aneurysms remain undiagnosed during lifetime. Their prevalence in the population is therefore higher. The manifestation of a ruptured aneurysm depends on its location and may involve intraperitoneal hemorrhage, gastrointestinal and portal system bleeding with concomitant portal hypertension and bleeding from esophageal varices. Wide access to diagnostic tests, for example ultrasound, computed tomography or magnetic resonance imaging, helps establish the correct diagnosis and a therapeutic plan as well as select appropriate treatment. After a procedure, the same diagnostic tools enable assessment of treatment efficacy, or are used for the monitoring of aneurysm size and detection of potential complications in cases that are ineligible for treatment. The type of treatment depends on the size of an aneurysm, the course of the disease, risk of rupture and risk associated with surgery or endovascular procedure. Endovascular treatment is preferred in most cases. Aneurysms are excluded from the circulation using embolization coils, ethylene vinyl alcohol, stents, multilayer stents, stent grafts and histoacryl glue (or a combination of these methods).

Gastrointestinal Endoscopy, 1999

... Patogenia. ; Diagnóstico. ; Endoscopía. ; Angiografía. ; Tratamiento. ; Estudio caso. ; Hombre. ; Aparato circulatorio patología. ; Vaso sanguíneo patología. ; Arteria patología. ; Aparato digestivo patología. ; Intestino patología. ; Farmacovigilancia. ; Radiodiagnóstico. ; Cirugía. ; ...

Journal of Society of Surgeons of Nepal, 2017

Introduction: Visceral artery aneurysms (VAA) are uncommon but important form of abdominal vascular disease. VAA frequently present as life-threatening emergencies. This study reviews our experience with management of VAA. Methods: It is a retrospective review of prospectively kept data of patients treated for visceral artery aneurysms in Tribhuvan University Teaching Hospital and Manmohan Cardiothoracic Vascular and Transplant Center from 1997 to 2009. Results: Fifteen patients were diagnosed with 16 visceral artery aneurysms. These consisted of 7 splenic (in 6 patients), 4 hepatic, 2 superior mesenteric, 1 gastroduodenal, and 1 renal artery aneurysms. There were 14 symptomatic patients including 4 who presented with rupture. Commonest presenting symptom was pain abdomen (14/15), followed by gastrointestinal bleed (6/15) and mass abdomen (5/15). The diagnosis was made with the help of CECT of abdomen in with obscure GI bleeding, diagnosis was clinched by conventional angiogram. Eight patients were treated only surgically, with three mortality. Transcatheter embolization alone was used in 5 patients. Two patients were treated with combination of surgical and endovascular therapy. One patient with superior mesenteric artery aneurysm in whom nothing could be done during laparotomy died six months later. Average follow up duration was one year. Conclusion: aneurysms. The VAAs can be treated surgically or with endovascular means with fair success, although the best mode of treatment needs to be individualized.

Annals of Vascular Surgery, 2013

Background: The aim of this study was to document the long-term results of open surgical treatment of aneurysms of the digestive arteries. Methods: Between January 2000 and March 2010, 60 patients were operated on for 78 aneurysms of the digestive arteries at our institution. The mean age of patients was 61 years (31e84 years). The average lesion diameter was 33 mm (range 10e90 mm). Topographic distribution involved the coeliac trunk in 23 cases (30%), hepatic artery in 20 (26%), splenic artery in 19 (24%), superior mesenteric artery in 11 (14%), gastroduodenal artery in 3 (4%), and pancreaticoduodenal arteries in 2 (3%). Twenty patients (33%) were symptomatic, 1 of whom presented with aneurysmal rupture (1.7%). Follow-up was prospective and an actuarial analysis was carried out. Only 3 patients (5%) were lost to follow-up. Results: Hospital mortality was 1.7% (upper gastrointestinal bleeding from gastric metastases of a kidney cancer). Postoperative complications were mainly respiratory (18%), digestive (18%), and renal (13%). Five reintervention procedures (8%) were necessary: 2 for colonic ischemia; 1 for intestinal bleeding; 1 for secondary graft infection due to peritonitis; and 1 for drainage of an acute pancreatitis. The average follow-up was 42 months (range 1e120 months). The actuarial survival rates were 98% at 1 month and 1 year, and 97% at 5 and 10 years, respectively. One late death occurred at 22 months (bronchopulmonary cancer). Three late reinterventions were carried out: 2 re-establishments of digestive continuity and 1 embolization for a recurrent aneurysm 7 years after the initial operation. The primary patency rate of the revascularizations was 98% at 1 month and 1 year, and 95% at 5 and 10 years. The rates of indemnity of restenosis or thrombosis were 98% at 1 month and 1 year, and 95% and 93% to 5 and 10 years, respectively. The rates of freedom of reintervention on bypasses were 98% at 1 month and 1 and 5 years, and 97% at 10 years. Conclusion: Open surgical treatment of aneurysms of the digestive arteries offers excellent long-term results in terms of patency. It is with these late results that endovascular techniques will have to be compared to define the best therapeutic strategy.