SUCCESSFUL MANAGEMENT OF 11 SPLANCHNIC ARTERY ANEURYSMS

Objective: To describe our experience with the management of aneurysms of the splanchnic arteries. Design: Retrospective study. Setting: Tea ching hospital, Norway. Subjects: Eleven consecutive patients with ane urysms of the splanchnic arteries treated between 1986 and 1996, six o f them between 1994 and 1996. Four aneurysms were hepatic (37%), two s plenic (18%), one coeliac (9%), one gastroepiploic (9%), one pancreati coduodenal (9%), one superior mesenteric (9%), and one jejunal (9%). F ive were pseudoaneurysms (46%). Interventions: Six patients (55%) were treated by operation, four (36%) by embolisation and one (9%) expecta ntly. Results: The pathogenesis was inflammatory (acute pancreatitis, anastomotic leak) in four patients (36%), athero-sclerotic in three (2 7%), arterial infusion of cytotoxic drugs in one (9%), and unknown in four (36%). Seven patients (64%) presented with rupture, two (18%) wit h other symptoms, and two patients (18%) were diagnosed incidentally. There was no mortality. Conclusion: There may be an increased incidenc e in splanchnic artery aneurysms, particularly those created by inflam matory lesions. The diagnosis should be suspected if acute bleeding oc curs during the course of severe intra-abdominal inflammation. Arterio graphy should be used to diagnose an aneurysm in haemodynamically stab le patients. Control of bleeding is obtained either by transarterial c atheter embolisation or by operation.