Analysis of Misdiagnosis Cause of 2 Patients with Spontaneous Rupture of Splenic Artery Aneurysm and the Litera-ture Review

TIAN Wan-guan; ZHANG Wen-tao; MENG Qing-yi

doi:10.3969/j.issn.1002-3429.2015.10.017

Abstract：Objective To investigate the clinical features and emergency diagnosis and treatment of splenic artery an-eurysm ( SAA) rupture. Methods Clinical data of two cases of SAA ruptures were retrospectively analyzed. We also re-viewed pertinent literature. Results A senior male patient complained of transient and severe epigastric pain for 7 days and was initially diagnosed with stomach illness in a local hospital. The symptom disappeared without any treatment. The patient suffered abrupt onset of unconsciousness combined with peritoneal hemorrhage and hemorrhagic shock after gastroscopy. Para-centesis revealed bloody fluid. According to the abdominal computed tomographic, the case was diagnosed as rupture of splen-ic artery aneurysm. The patient was given interventional embolization of the splenic artery; the other case was a middle-aged male, admitted to a local hospital for severe abdominal pain. The patient was initially misdiagnosed with acute pancreatitis, and septic shock. After fluid resuscitation, emergency bedside ultrasound and abdominal CT scan revealed diffuse hemoperito-neum without a clear source. After fluid resuscitation, laparotomy revealed excessive intraperitoneal hemorrhage due to a rup-tured SAA. The patient underwent a ligation of the proximal portion of the artery together with resection of the aneurysm and spleen and the he was cured. Conclusion Splenic artery aneurysm ( SAA) is a rare disease and potentially life-threatening clinical entity that carries a risk of rupture and peritoneal hemorrhage. Splenic artery aneurysm ruptures should be considered in the differential diagnosis in any patient with undifferentiated hemoperitoneum and shock. Early diagnosis and treatment are crucial for the patient's survival.