Advertisement

Surgical Endoscopy

, Volume 24, Issue 9, pp 2318–2320 | Cite as

Laparoscopic distal pancreatectomy and splenectomy for splenic artery aneurysm

  • Brandon T. Grover
  • Sigurd B. GundersenIII
  • Shanu N. KothariEmail author
Video

Abstract

Background

Large splenic artery aneurysms are rare but comprise 60% of all visceral artery aneurysms. Most are found incidentally and rupture in the nonpregnant patient has an approximate 25 to 36% mortality rate. Historically these have been managed with an open surgical approach for resection.

Methods

We present the case of a 43-year-old man with a recent episode of bacterial endocarditis with an incidental finding of a large 6-cm splenic artery aneurysm. There was noted to be splenic vein occlusion and multiple splenic infarcts versus abscesses on preoperative imaging. There were concerns that this represented a mycotic aneurysm. He underwent laparoscopic en bloc splenic artery aneurysm resection with splenectomy and distal pancreatectomy with preoperative prophylactic balloon catheter placement.

Results

His large splenic artery aneurysm was adjacent to the splenic hilum. Due to the splenic vein occlusion, there were large collateral vessels complicating the dissection. Additionally, the aneurysm had dense adhesions to the tail of the pancreas from a desmoplastic reaction. To safely remove the aneurysm, a distal pancreatectomy was included with resection of the spleen. The specimen was successfully removed intact using the laparoscopic approach. The patient had an uneventful recovery and was discharged home on postoperative day 2. Final pathology revealed no evidence of bacterial etiology.

Conclusions

Laparoscopic distal pancreatectomy with splenectomy is an appropriate minimally invasive option for the treatment of splenic artery aneurysms. This video demonstrates the technical challenges and management options for successfully completing a distal pancreatectomy and splenectomy in the face of a splenic artery aneurysm.

Keywords

Laparoscopic Pancreatectomy Splenectomy Splenic artery aneurysm 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Notes

Disclosures

Drs. Brandon T. Grover and Sigurd B. Gundersen, 3rd have no conflicts of interest or financial ties to disclose. Dr. Shanu N. Kothari serves as a consultant for ValleyLab and LifeCell as well as Covidien, which provides fellowship grant support.

Supplementary material

Supplementary material 1 (MPG 73813 kb) The corresponding video was presented at SAGES 2009 Scientific Sessions on April 25, 2009 in Phoenix, AZ

References

  1. 1.
    Shanley CJ, Weinberger JB (2008) Acute abdominal vascular emergencies. Med Clin North Am 92:627–647, ixGoogle Scholar
  2. 2.
    Long CD, Bakshi KR, Kahn MB, Roberts AB (1993) Giant splenic artery aneurysm. Ann Vasc Surg 7:474–478CrossRefPubMedGoogle Scholar
  3. 3.
    Trastek VF, Pairolero PC, Joyce JW, Hollier LH, Bernatz PE (1982) Splenic artery aneurysms. Surgery 91:694–699PubMedGoogle Scholar
  4. 4.
    Mattar SG, Lumsden AB (1995) The management of splenic artery aneurysms: experience with 23 cases. Am J Surg 169:580–584CrossRefPubMedGoogle Scholar
  5. 5.
    Abbas MA, Stone WM, Fowl RJ, Gloviczki P, Oldenburg WA, Pairolero PC, Hallett JW, Bower TC, Panneton JM, Cherry KJ (2002) Splenic artery aneurysms: two decades experience at Mayo Clinic. Ann Vasc Surg 16:442–449CrossRefPubMedGoogle Scholar
  6. 6.
    Dave SP, Reis ED, Hossain A, Taub PJ, Kerstein MD, Hollier LH (2000) Splenic artery aneurysm in the 1990s. Ann Vasc Surg 14: 223–229CrossRefPubMedGoogle Scholar
  7. 7.
    Lai R, Mallery S (2002) Primary splenic artery aneurysm diagnosed by EUS. Vis Hum J Endosonogr 1:2–3Google Scholar
  8. 8.
    Messina LM, Shanley CJ (1997) Visceral artery aneurysms. Surg Clin North Am 77:425–442CrossRefPubMedGoogle Scholar
  9. 9.
    Stanley JC, Wakefield TW, Graham LM, Whitehouse WM Jr, Zelenock GB, Lindenauer SM (1986) Clinical importance and management of splanchnic artery aneurysms. J Vasc Surg 3: 836–840CrossRefPubMedGoogle Scholar
  10. 10.
    de Perrot M, Buhler L, Deleaval J, Borisch B, Mentha G, Morel P (1998) Management of true aneurysms of the splenic artery. Am J Surg 175:466–468CrossRefPubMedGoogle Scholar
  11. 11.
    Meinke AK, Floch NR, Dicorato MP (2002) Laparoscopic options in the treatment of splenic artery aneurysms. Surg Endosc 16:1107PubMedGoogle Scholar
  12. 12.
    Roland J, Brody F, Venbrux A (2007) Endovascular management of a splenic artery aneurysm. Surg Laparosc Endosc Percutan Tech 17:459–461CrossRefPubMedGoogle Scholar
  13. 13.
    Arca MJ, Gagner M, Heniford BT, Sullivan TM, Beven EG (1999) Splenic artery aneurysms: methods of laparoscopic repair. J Vasc Surg 30:184–188CrossRefPubMedGoogle Scholar
  14. 14.
    Bakhos CT, McIntosh BC, Nukta FA, Fiedler PN, Denatale RW, Sweeney TF, Ferneini AM (2007) Staged arterial embolization and surgical resection of a giant splenic artery aneurysm. Ann Vasc Surg 21:208–210CrossRefPubMedGoogle Scholar
  15. 15.
    Kokkalera U, Bhende S, Ghellai A (2006) Laparoscopic management of splenic artery aneurysms. J Laparoendosc Adv Surg Tech A 16:604–608CrossRefPubMedGoogle Scholar
  16. 16.
    de Csepel J, Quinn T, Gagner M (2001) Laparoscopic exclusion of a splenic artery aneurysm using a lateral approach permits preservation of the spleen. Surg Laparosc Endosc Percutan Tech 11:221–224PubMedGoogle Scholar
  17. 17.
    Pulli R, Dorigo W, Troisi N, Pratesi G, Innocenti AA, Pratesi C (2008) Surgical treatment of visceral artery aneurysms: a 25-year experience. J Vasc Surg 48:334–342CrossRefPubMedGoogle Scholar
  18. 18.
    Jimenez RE, Mavanur A, Macaulay WP (2007) Staple line reinforcement reduces postoperative pancreatic stump leak after distal pancreatectomy. J Gastrointest Surg 11:345–349CrossRefPubMedGoogle Scholar
  19. 19.
    Pierce RA, Spitler JA, Hawkins WG, Strasberg SM, Linehan DC, Halpin VJ, Eagon JC, Brunt LM, Frisella MM, Matthews BD (2007) Outcomes analysis of laparoscopic resection of pancreatic neoplasms. Surg Endosc 21:579–586CrossRefPubMedGoogle Scholar
  20. 20.
    Pugliese R, Maggioni D, Sansonna F, Scandroglio I, Forgione A, Boniardi M, Costanzi A, Citterio D, Ferrari GC, Lernia SD, Magistro C (2008) Laparoscopic distal pancreatectomy: a retrospective review of 14 cases. Surg Laparosc Endosc Percutan Tech 18:254–259CrossRefPubMedGoogle Scholar
  21. 21.
    Thaker RI, Matthews BD, Linehan DC, Strasberg SM, Eagon JC, Hawkins WG (2007) Absorbable mesh reinforcement of a stapled pancreatic transection line reduces the leak rate with distal pancreatectomy. J Gastrointest Surg 11:59–65CrossRefPubMedGoogle Scholar
  22. 22.
    Yamamoto M, Hayashi MS, Nguyen NT, Nguyen TD, McCloud S, Imagawa DK (2009) Use of SeamGuard to prevent pancreatic leak following distal pancreatectomy. Arch Surg 144:894–899CrossRefPubMedGoogle Scholar
  23. 23.
    Ha JF, Sieunarine K (2009) Laparoscopic splenic artery aneurysm resection: review of current trends in management. Surg Laparosc Endosc Percutan Tech 19:e67–e70CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Brandon T. Grover
    • 1
  • Sigurd B. GundersenIII
    • 2
  • Shanu N. Kothari
    • 2
    Email author
  1. 1.Department of Medical EducationGundersen Lutheran Medical FoundationLa CrosseUSA
  2. 2.Department of SurgeryGundersen Lutheran Health SystemLa CrosseUSA

Personalised recommendations