Search

Background/Aim: Understanding different surgical approaches and anatomical landmarks adjacent to the splenic artery (SpA) is important for safe robotic distal pancreatectomy (RDP). Herein, we propose our standardized RDP techniques, focusing on these issues. Patients and Methods: Between April 2021 and April 2022, 19 patients who underwent RDP at our Institution were reviewed. Anatomical patterns of the SpA were classified into three types: Type 1, no pancreatic parenchyma on the root of the SpA; type 2, any pancreatic parenchyma on the root of the SpA; and type 3, dorsal pancreatic artery around the bifurcation of the common hepatic artery and SpA. Next, the surgical strategy for approaching the SPA was determined according to the location of the pancreatic transection line: On the superior mesenteric vein (SMV) or on the left side of the root of the SpA. Results: There were seven cases of type 1, nine cases of type 2, and three cases of type 3. When transecting the pancreas on the SMV, the SpA-first ligation technique was used for type 1 SpA anatomy, and the pancreas-first division technique was applied for types 2 and 3. In patients in whom the pancreas was transected at the left side of the root of the SpA, the SpA-first ligation technique was used. Conclusion: Our standardized surgical strategy based on anatomical landmarks and focusing on the approach to the SpA in RDP is demonstrated. Our strategy should help trainees approach the SpA and perform RDP safely.

Objective: To describe four consecutive cases of splenic artery aneurysm (SAA) with different clinical patterns of presentation among obstetrical patients. Methods: A series of four cases of SAA diagnosed in pregnant or postpartum women at our University center between January 1998 and December 2020. Clinical and radiologic data were retrospectively obtained by reviewing paper and electronic medical records after acquiring patient’s consent. Results: One case was completely asymptomatic and incidentally identified at the beginning of pregnancy, thus allowing for multidisciplinary treatment. The other three cases were unknown: two manifested with maternal collapse due to aneurysm rupture in the third trimester of gestation, whereas one presented with acute abdominal pain during the postpartum period and was successfully managed before rupture occurred. Conclusion: Although extremely rare, SAA rupture in obstetrical patients can be associated with dramatic consequences. Early suspicion and prompt intervention are essential to avoid fatal outcomes, so promotion of knowledge of all the potential clinical patterns of presentation of SAA rupture among obstetrical patients is mandatory.

Background:To treat small-for-size syndrome (SFSS) after living donor liver transplantation (LDLT), many procedures were described for portal flow modulation before, during, or after transplantation. The selection of the procedure as well as the best timing remains controversial. Case presentation:A 43-year-old female with end-stage liver disease underwent LDLT with extended left with caudate lobe graft from her donor who was her 41-year-old brother (graft volume/standard liver volume (GV/SLV), 35.7%; graft to recipient weight ratio (GRWR), 0.67%). During the surgery, splenectomy could not be performed owing to severe peri-splenic adhesions to avoid the ruined bleedings. The splenic artery ligation was not also completely done because it was dorsal to the pancreas and difficult to be approached. Finally, adequate portal vein (PV) inflow was confirmed after portal venous thrombectomy. As having post-transplant optional procedures that are accessible for PV flow modulation, any other procedures for PV modulation during LDLT were not done until the postoperative assessment of the graft function and PV flow for possible postoperative modulation of the portal flow accordingly. Postoperative PV flow kept as high as 30 cm/s. By the end of the 1st week, there was a progressive deterioration of the total bilirubin profile (peak as 19.4 mg/dL) and ascitic fluid amount exceeded 1000 mL/day. Therefore, splenic artery embolization was done effectively and safely on the 10th postoperative day (POD) to reverse early allograft dysfunction as PV flow significantly decreased to keep within 20 cm/s and serum total bilirubin levels gradually declined with decreased amounts of ascites below 500 mL on POD 11 and thereafter. The patient was discharged on POD 28 with good condition. Conclusions:SFSS can be prevented or reversed by the portal inflow modulation, even by post-transplant procedure. This case emphasizes that keeping accessible angiographic treatment options for PV modulation, s

Background: Recent data indicate that kidney stone formers (KSFs) may have increased biomineralization at anatomic sites throughout the body compared with nonstone formers (NSFs). The objective of this study is to compare the volume of nonrenal systemic calcifications between KSF and NSF by using a standardized system to analyze calcifications in the abdominal aorta (AA) and splenic artery (SA). Methods: The NSF cohort was obtained from a kidney donor's prospectively maintained database. One hundred ninety-seven NSF were matched to 197 KSF based on age, gender, and body mass index. Noncontrast CT scans were evaluated and semiautomated CT software was utilized to provide an AA and SA calcification Agatston score. Wilcoxon rank-sum test was used on continuous variables and chi-squared test or Fisher's exact test on categorical variables. Odds ratios (ORs) were given for a variable's influence on the formation of stones or calcifications. Results: AA and SA calcifications were more prevalent in the KSF group (p = 0.011 and p = 0.027, respectively). KSFs were 1.9 times more likely to have intermediate or severe AA calcification than NSFs (OR = 1.9, p = 0.004). Severe AA calcifications had even a greater association (OR = 3.1, p = 0.019). KSFs were also more likely to have SA, but this did not reach statistical significance (OR = 3.7, p = 0.103). Conclusion: Patients with increased systemic calcifications, specifically aortic or splenic calcifications, may be at an increased risk for future kidney stone formation. Patients with these imaging findings and additional risk factors for stone disease may be counseled on the future risk of stones.

Background: Recent data indicate that kidney stone formers (KSFs) may have increased biomineralization at anatomic sites throughout the body compared with nonstone formers (NSFs). The objective of this study is to compare the volume of nonrenal systemic calcifications between KSF and NSF by using a standardized system to analyze calcifications in the abdominal aorta (AA) and splenic artery (SA). Methods: The NSF cohort was obtained from a kidney donor's prospectively maintained database. One hundred ninety-seven NSF were matched to 197 KSF based on age, gender, and body mass index. Noncontrast CT scans were evaluated and semiautomated CT software was utilized to provide an AA and SA calcification Agatston score. Wilcoxon rank-sum test was used on continuous variables and chi-squared test or Fisher's exact test on categorical variables. Odds ratios (ORs) were given for a variable's influence on the formation of stones or calcifications. Results: AA and SA calcifications were more prevalent in the KSF group (p = 0.011 and p = 0.027, respectively). KSFs were 1.9 times more likely to have intermediate or severe AA calcification than NSFs (OR = 1.9, p = 0.004). Severe AA calcifications had even a greater association (OR = 3.1, p = 0.019). KSFs were also more likely to have SA, but this did not reach statistical significance (OR = 3.7, p = 0.103). Conclusion: Patients with increased systemic calcifications, specifically aortic or splenic calcifications, may be at an increased risk for future kidney stone formation. Patients with these imaging findings and additional risk factors for stone disease may be counseled on the future risk of stones.

Background: Recent data indicate that kidney stone formers (KSFs) may have increased biomineralization at anatomic sites throughout the body compared with nonstone formers (NSFs). The objective of this study is to compare the volume of nonrenal systemic calcifications between KSF and NSF by using a standardized system to analyze calcifications in the abdominal aorta (AA) and splenic artery (SA). Methods: The NSF cohort was obtained from a kidney donor's prospectively maintained database. One hundred ninety-seven NSF were matched to 197 KSF based on age, gender, and body mass index. Noncontrast CT scans were evaluated and semiautomated CT software was utilized to provide an AA and SA calcification Agatston score. Wilcoxon rank-sum test was used on continuous variables and chi-squared test or Fisher's exact test on categorical variables. Odds ratios (ORs) were given for a variable's influence on the formation of stones or calcifications. Results: AA and SA calcifications were more prevalent in the KSF group (p = 0.011 and p = 0.027, respectively). KSFs were 1.9 times more likely to have intermediate or severe AA calcification than NSFs (OR = 1.9, p = 0.004). Severe AA calcifications had even a greater association (OR = 3.1, p = 0.019). KSFs were also more likely to have SA, but this did not reach statistical significance (OR = 3.7, p = 0.103). Conclusion: Patients with increased systemic calcifications, specifically aortic or splenic calcifications, may be at an increased risk for future kidney stone formation. Patients with these imaging findings and additional risk factors for stone disease may be counseled on the future risk of stones.

Задачей данной работы явилось изучение и дополнение имеющиеся данных о макро-микроскопическом строении и топографии селезенки кролика. В данном исследовании применены анатомические и гистологические методы изучения. Полученые результаты исследования селезенки кролика дополняют и подтверждают имеющиеся данные о топографии селезенки. В процессе исследования было установленно, что селезеночные ветви образуют 4–5 сегментарных артерий, которые в дальнейшем разветвляются на трабекулярные артерии. Группа пульпарных артерий достигают диаметра – 0,2 мм, окруженные лимфоидными периартериальными влагалищами и селезеночными лимфоидными узелками., The objective of this study was to study and supplement the available data on the macro-microscopic structure and topography of the rabbit's spleen. In this study, anatomical and histological methods were used. The results of the rabbit spleen study complement and confirm the available data on the topography of the spleen. In the course of the study, it was established that the splenic branches form 4–5 segmental arteries, which further branch into the trabecular arteries. The group of pulpary arteries reaches a diameter of 0.2 mm, surrounded by lymphoid periarterial sheaths and splenic lymphoid nodules.

Задачей данной работы явилось изучение и дополнение имеющиеся данных о макро-микроскопическом строении и топографии селезенки кролика. В данном исследовании применены анатомические и гистологические методы изучения. Полученые результаты исследования селезенки кролика дополняют и подтверждают имеющиеся данные о топографии селезенки. В процессе исследования было установленно, что селезеночные ветви образуют 4–5 сегментарных артерий, которые в дальнейшем разветвляются на трабекулярные артерии. Группа пульпарных артерий достигают диаметра – 0,2 мм, окруженные лимфоидными периартериальными влагалищами и селезеночными лимфоидными узелками., The objective of this study was to study and supplement the available data on the macro-microscopic structure and topography of the rabbit's spleen. In this study, anatomical and histological methods were used. The results of the rabbit spleen study complement and confirm the available data on the topography of the spleen. In the course of the study, it was established that the splenic branches form 4–5 segmental arteries, which further branch into the trabecular arteries. The group of pulpary arteries reaches a diameter of 0.2 mm, surrounded by lymphoid periarterial sheaths and splenic lymphoid nodules.

Background and aimsCVD risks associated with coronary artery calcification (CAC) and aortic calcification (AC) are well known, but less is known about other calcified arteries. We aimed to assess the associations of arterial calcification in the breast, splenic, and internal and external iliac arteries with CVD risk factors and mortality.MethodsWe conducted a case-cohort study nested in a cohort of 5196 individuals who self-referred or were referred by a health care provider for whole body computed tomography (CT), including a random subcohort (n = 395) and total and CVD mortality cases (n = 298 and n = 90), who died during a median follow-up of 9.4 years. Arterial calcification in the breast, splenic, and internal and external iliac arteries on CT was scored using a simple visual score. AC and CAC were previously measured using the Agatston technique. Logistic regression models were made to study associations of CVD risk factors with calcification in the different vascular beds. Prentice-weighted Cox proportional hazards models adjusted for CVD risk factors, and calcification in other vascular beds, were used to study associations with mortality.ResultsIn the subcohort, the mean age was 56.6 years (SD 11.1) and 41.3% were female. The prevalence of calcification on CT, was 11.6% in the splenic, 47.9% in the internal iliac and 9.5% in the external iliac arteries, while 3.7% of women had breast artery calcification (BAC). Calcification in the splenic and iliac arteries was associated with calcification in the abdominal aorta but differentially associated with other CVD risk factors in logistic regression models. The prevalence of BAC was too low to fit these multivariable models. Calcification of the external iliac arteries was significantly associated with both all-cause and CVD mortality, but no longer significant when adjusted for CVD risk factors. Breast artery calcification was associated with both all-cause and CVD mortality indepen

We would like to report our experience of a rather rare complication that occurred in a 76-year old patient tree years after endovascular repair of a splenic artery pseudoaneurysm with a covered stent. Three years after stent insertion, the patient complained of mild abdominal pain and melena; it was revealed endoscopically that the covered stent has eroded the stomach wall and migrated into the stomach. The splenic artery is the most common location among the spectrum of potential presentation sites of visceral arteries aneurysms and pseudoaneurysms. Endovascular treatment with the use of coils or stents is the first option due to lower morbidity and mortality than open surgery. Endovascular repair may also lead to complications and patients need to be followed up in order to confirm aneurysm sealing, and exclude late complication. Minor stent graft migration may occur in the long term, however extra vascular migration is extremely rare.

Splenic artery aneurysm rupture is rare and potentially fatal. It has largely been reported in pregnant patients and typically not diagnosed until laparotomy. This case reports a constellation of clinical and sonographic findings that may lead clinicians to rapidly diagnose ruptured splenic artery aneurysm at the bedside. We also propose a rapid, but systematic sonographic approach to patients with atraumatic hemoperitoneum causing shock. It is yet another demonstration of the utility of bedside ultrasound in critically ill patients, specifically with undifferentiated shock.

Splenic artery aneurysm rupture is rare and potentially fatal. It has largely been reported in pregnant patients and typically not diagnosed until laparotomy. This case reports a constellation of clinical and sonographic findings that may lead clinicians to rapidly diagnose ruptured splenic artery aneurysm at the bedside. We also propose a rapid, but systematic sonographic approach to patients with atraumatic hemoperitoneum causing shock. It is yet another demonstration of the utility of bedside ultrasound in critically ill patients, specifically with undifferentiated shock.

BackgroundRegional chemotherapy is used successfully in the treatment of both primary and secondary malignancies, in particular of the peritoneal surface and the liver, and is currently explored as an attractive approach for patients with locally advanced pancreatic ductal adenocarcinoma. To establish the feasibility and toxicity of regional intra-arterial gemcitabine delivered as a 24-h continuous infusion to the pancreas as a novel treatment option for patients with locally advanced PDAC a phase I clinical trial was conducted.MethodsBetween April 2011 and September 2013 six patients with biopsy confirmed, borderline or unresectable pancreatic adenocarcinoma, and having received at least one line of systemic chemotherapy, underwent vascular redistribution of the inflow to the head of the pancreas by arterial coil embolization followed by perfusion catheter placement within the splenic artery. Patients were treated with increasing doses of gemcitabine administered by continuous splenic arterial infusion over 24 h with inter-patient and intra-patient dose escalation scheme. The primary endpoint was toxicity of the intra-arterial gemcitabine regimen and to establish the maximum tolerated dose.ResultsCatheter placement and gemcitabine infusion was successful in all patients enrolled to date (n = 6). Four out of six patients experienced catheter tip migration requiring replacement or revision. Patients received a median of four doses of 24-h gemcitabine infusion. Two patients developed grade 3 and 4 duodenal ischemia and upper gastrointestinal bleeding. Median overall survival was 15.3 months and median time to progression was 3 months. Three patients (50 %, n = 3/6) progressed systemically. Two patients had stable disease >4 months following treatment and underwent pancreaticoduodenectomy.ConclusionsWhile technically feasible to treat locally advanced pancreatic ductal adenocarcinoma, prolonged regional pancreatic perfusion with gemcitabine following pancreatic arte

Aneurysm of the splenic artery which arises from the superior mesenteric artery is a very rare condition with less than twenty cases described in the literature. Most of the time, it is asymptomatic and the diagnosis is fortuitous, but the patient can feel epigastric or left upper quadrant discomfort. One can palpate an abdominal mass or hear an abdominal systolic murmur. The most fatal presentation is the life-threatening rupture. We report the case of a 41-year-old woman presenting an aneurysm of the splenic artery originating from the superior mesenteric artery treated surgically by simple aneurismal resection with neither arterial reconstruction nor splenectomy. The different treatment modalities are discussed, taking into account the presence of the vascular malformation.

Splenic artery aneurysm (SAA) is a rare complication after orthotopic liver transplantation (OLT). Although SAAs are often incidental findings, in some cases they present with signs and symptoms of abdominal mass or intra-abdominal hemorrhage. The diagnosis requires Doppler ultrasound and confirmation with computed tomography, magnetic resonance, or angiography. Endovascular techniques are preferred to surgery for the treatment of most SAAs. A variable interval from 6 days to 11 years has been reported between OLT and the diagnosis of SAA, justifying a lifelong scheduled surveillance of abdominal vessels by ultrasound after OLT. Herein we have reported a case of SAA that developed 16 years after OLT. This pathological condition was totally asymptomatic. Only routine abdominal ultrasound allowed its detection and subsequent successful treatment. © 2009 Elsevier Inc. All rights reserved.

The incidence of splenic artery aneurysm (SAA) in patients with cirrhosis ranges from 7 per cent to 17 per cent. SAA rupture after liver transplantation (LT) is reported to result in significant morbidity and mortality. We report our experience with SAA in LT candidates. From September 1995 through August 2002, 14 LT candidates were diagnosed with SAA. Twenty SAA occurred in 14 patients with an average diameter of 20 mm. Eleven patients qualified for LT; to date, seven have been transplanted. No intervention for SAA occurred prior to LT. Of the seven patients transplanted, four had SAA identified prior to LT. Three were treated at LT and are alive; the fourth had postoperative splenic artery embolization followed by splenectomy and expired on day 109 from duodenal ulcer complications. Three of seven patients had undiagnosed SAA at LT. One required emergency splenectomy for SAA rupture and is alive at 44 months. The remaining two received no treatment; one suffered a late septic death and one is alive at 15 months. No ruptures occurred in our pre-LT population, suggesting that definitive management can await LT. We recommend that all patients undergo four-phase computed tomography or magnetic resonance angiography (MRA) as part of the LT evaluation and that identified SAA be resected at transplantation.

True aneurysm of the splenic artery is rare. Two cases of ruptured true splenic artery aneurysms are presented. The first patient was a 62-year-old female who presented within 6 hours of the onset of symptoms. The other was a 27-year-old non-alcoholic male patient who was admitted in a state of shock after 2 days of observation in a peripheral hospital. Both patients had haemoperitoneum and were subjected to exploratory laparotomy. Aneurysmectomy was performed in both the patients in addition to left splenopancreatectomy in the first case and splenectomy in the second. However, due to the prolonged preoperative shock, the second patient succumbed on the third postoperative day.

OBJECTIVE: Blood flow characteristics of right gastroepiploic artery and saphenous vein conduits were compared during bypass surgery. METHODS: This study is based on a consecutive series of 97 patients undergoing a bypass graft to the right coronary artery, posterior descending artery, or posterolateral branch using either a pediculated right gastroepiploic artery (n = 52) or a saphenous vein (n = 45) bypass graft. Flows and velocity profiles were measured with an 8-MHz pulsed-wave Doppler ultrasound flowmeter. Thorough flow measurements were made (1) after cessation of cardiopulmonary bypass and (2) before chest closure. RESULTS: At the end of cardiopulmonary bypass, flow in the right gastroepiploic artery (59. 0 +/- 6.7 mL/min) did not differ (P =.08) from flow in the saphenous vein (46.1 +/- 2.7 mL/min). Mean trace velocity was 11.9 +/- 0.7 cm/s in the right gastroepiploic artery and 11.6 +/- 0.8 cm/s in the saphenous vein (P =.80), but peak systolic velocity was 29.4 +/- 1.2 cm/s for the right gastroepiploic artery and 23.1 +/- 1.3 cm/s for the saphenous vein (P <.001). Likewise, before chest closure, flow was 57.1 +/- 4.7 mL/min in the right gastroepiploic artery and 46.5 +/- 4.0 mL/min in the saphenous vein (P =.10), mean velocity was 12. 9 +/- 0.7 and 11.6 +/- 0.8 cm/s, respectively (P = .22), and systolic peak velocity was 30.0 +/- 1.2 and 22.3 +/- 1.2 cm/s, respectively (P < .001). CONCLUSIONS: There were no flow differences between right gastroepiploic artery and saphenous vein grafts implanted into the same coronary bed in comparable groups of patients. Waveform shape of the right gastroepiploic artery grafts was characterized by a wider spectral dispersion resulting in a higher maximal frequency.

The authors report 3 cases of thromboembolic splenic infarction due to atherosclerosis of the thoracic aorta and the splenic artery. On this occasion, a retrospective analysis of 64 splenic infarcts showed that, in contrast to the literature, the leading aetiology in our series consisted of haematologic disorders (50%), followed by cardiovascular diseases (29%) and by digestive disorders (20%). Mean age was 58 +/- 17 years and 50% of the patients were aged below 60 years. Hospital mortality rate was high (34%) but not directly related to splenic infarction, suggesting that splenic infarction often occurs in the setting of severe underlying diseases. Splenic infarct is part of the differential diagnosis of the left upper quadrant pain and can also mimic renal disorders. Laboratory values may show an inflammatory syndrome and an increase in serum lactate deshydrogenase. Diagnosis is often made by CT scan and can be confirmed by a selective spleen scintigraphy. Transoesophageal echocardiography is essential in the detection of cardiac and thoracic aorta embolic material.

The natural history of pseudoaneurysms complicating pancreatitis is unknown. A patient with chronic pancreatitis is described in whom thrombosis of a splenic artery pseudoaneurysm occurred. Early diagnosis and radical treatment of a bleeding pseudoaneurysm are mandatory. When elective treatment is considered, however, contrast enhanced computed tomography may be useful just before surgery as thrombosis may occur.

info:eu-repo/semantics/published