Amit Kaul, MD, Ulises Garza, MD, Angela Echeverria, MD, Felipe Maegawa, MD, Carlos Galvani, MD. Section of Minimally Invasive and Robotic Surgery, Department of Surgery, University of Arizona
Introduction
Splenic artery aneurysms (SAA) are a rare entity, and commonly diagnosed incidentally. They are the third most common site of intra-abdominal aneurysms. Its association with pregnancy poses an increased risk of rupture; and they are associated with at least a maternal mortality risk of 50%; and fetal mortality rate between 70 – 90%. We present a case of a pregnant patient with symptomatic SAA, managed laparoscopically.
Methods
38-year-old multiparous patient, diagnosed with a Splenic Artery aneurysm (SAA) incidentally in 2010 at an outside hospital. Subsequently, the patient became pregnant and started to have have symptoms towards the end of her second trimester, her symptoms included moderate to severe left upper quadrant pain. Failed embolization was attempted at that institution with worsening of the patient’s symptoms. Patient was transferred to our institution. A CT angiogram revealed a 1.6cm saccular SAA without any evidence of extravasation or rupture. Patient was offered Laparoscopic Splenectomy with resection of the splenic artery aneurysm after clearence by her obstetrician.
Patient was placed in right lateral decubitus position. A total of four bladeless trocars, 15mm, 10mm and two 5mm, were inserted in under vision. The gravid uterus was visualized intact. The spleen was freed from its ligaments. The splenic artery was dissected proximally until the SAA was found. A linear stapler white load with staple line reinforcement was used to divide the splenic artery and vein. The spleen was taken out in an endo-bag. All the trocars were removed under vision. The fetal status was unaltered.
Results
Operating time was 90 minutes, estimated blood loss was 5cc. The fetal heart rate in the immediate post-operative period was 150 -155 bpm. No intraoperative or postoperative complications were observed. Patient was discharged from our care on post-operative day 3.
Conclusion
Early diagnosis and treatment of this rare condition is essential. In the elective setting, laparoscopic surgery is technically feasible and potentially beneficial for the patient as well the fetus in terms of less operative stress and early recovery.
Session Number: SS21 – Videos: Solid Organ & Foregut
Program Number: V045