PP161 A CASE OF SPONTANEOUS RUPTURED OF SPLENIC ARTERY ANEURYSM: Red-flag fitting: A case of spontaneous ruptured of splenic artery aneurysm

Abstract

Red-flag fitting: A case of spontaneous ruptured of splenic artery aneurysm

Abstract

Introduction

Splenic artery aneurysms are a rare entity with very low incident rate of 0.09% of population. They are often asymptomatic and frequently incidental finding during abdominal imaging or when catastrophic leaking occur. Here we report a case of spontaneous ruptured of splenic artery aneurysm presented with fitting.

Case Report

30 years old Malay gentleman presented to us after 2 episodes of fitting while attending to his child funeral. On arrival, patient was alert but appeared pale, lethargic, tachypnic and his abdominal was guarded and tender. He was hypotensive with BP of 82/48mmHg and PR was 138/min. Laboratory test showed that his hemoglobin was 7.8g/dl. Ultrasound abdomen revealed intraabdominal free fluid over hepatorenal area. Massive transfusion protocol was initiated and proceeded with emergency exploratory laparotomy. Intraoperatively, noted bleeding from rupture splenic artery likely secondary to ruptured splenic artery aneurysm. Splenectomy was done and specimen was sent for histopathological analysis. A total blood loss was estimated around 10L. Histological analysis noted cystic lesion over splenic artery and confirmed the presence of arterial wall aneurysm.

Discussion and Conclusion

The diagnosis of spontaneous ruptured splenic artery aneurysm is very challenging and it carries a high morbidity and mortality rate. In this case, patient initially presented with fitting could be due to hypovolemic shock that leads to hypoperfusion to the brain. Patients may have cardiovascular syncope with abnormal limb movements due to cerebral hypoxia, which it may sometimes be difficult to differentiate from epilepsy. The abrupt onset of non-traumatic severe hemodynamic shock in a patient without medical history should raise suspicion of spontaneous rupture of splenic aneurysm. Rapid diagnosis and aggressive volume replacement and prompt surgical intervention shows favourable outcome.