TAEから開腹術を行った脾動脈瘤破裂の1例

抄録

We report a case of a ruptured splenic artery aneurysm. A 69-year-old man complained of sudden upper abdominal pain and his consciousness diminished transiently. He was transferred to our hospital by ambulance. In our emergency room, he was alert and complained of continuous abdominal pain. During our medical examination, he showed syncope and fell into shock. Enhanced computed tomography showed an intra-abdominal hemorrhage and a splenic artery aneurysm. Transcatheter arterial embolization (TAE) to the splenic artery was performed using platinum microcoils, and his hemodynamics stabilized immediately. However, his urine output decreased and metabolic acidosis appeared gradually. An exploratory laparotomy seven hours after TAE showed a huge intraperitoneal hematoma and paleness of the visceral organs. The hematoma was removed and the color of the organs improved. Splenectomy and resection of the splenic artery aneurysm were performed. His postoperative course was uneventful. Recently, the efficacy of TAE for splenic artery aneurysms has been reported. In our case, the hemostasis of the ruptured aneurysm was achieved by TAE, but laparotomy was required because of a huge intra-abdominal hematoma. We emphasize that close observation is needed after a hemostasis is performed by TAE in the case of a ruptured splenic artery aneurysm.