SPLENIC VEIN ANEURYSM

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Splenic vein aneurysms(SVA) are rare with the reported incidence among visceral venous aneurysms approximately 14%. Herein, we present a case of splenic aneurysm presenting to intensive care in shock requiring interventional management. CASE PRESENTATION: 57 year old female presented hospital abdominal discomfort and weakness, found hypotensive which improved volume resuscitation. She has history chronic pancreatitis previously complicated by infected pancreatic pseudocyst drain placement that was subsequently removed. CT angiogram showed several pseudoaneurysms, an already known new hemorrhagic component. underwent arterial angiography however no embolization performed since pseudoaneurysms bleeding source could not be identified. After returning, patient became further resuscitation vasopressors. Repeat Angiogram filling portal phase concerning for aneurysm. Through common femoral artery, she procedure distal artery decrease blood flow. started on meropenem fluid aspiration grew E. coli. Since there concern component pseudocyst, deferred. Patient continued improve medical management discharged IV antibiotics. In outpatient setting, repeat increase size 40% therefore ultrasound guided percutaneous thrombin performed. One week later, complete thrombosis DISCUSSION: summary, this is who possible mixture septic SVAs incidental occurrences most patients being asymptomatic. The causes SVA include hypertension, or congenital weakness vessel wall. Small usually asymptomatic whereas larger ones( >3cm diameter) described cause complications including thrombosis, duodenal/biliary obstruction, rupture into GI tract intraperitoneally. diagnosis can made using imaging. For symptomatic aneurysms, optimal intervention unclear. Available approaches trans-hepatic trans-splenic approach. transhepatic approach safer comparatively because easy access system, high vascularity spleen fragility its vessels. CONCLUSIONS: clinical entity best treatment option As more cases natural disease process understood, better strategies formulated. REFERENCE #1: Juscafresa LC, Alfaro MP, Grochowicz L, Lorenzo JIL, Jaureguizar JIB. Endovascular through Diagn Interv Radiol. 2019;25(2):166-168. doi:10.5152/dir.2019.18057 DISCLOSURES: No relevant relationships Rahul Bollam, source=Web Response Florencio Mamauag,