Delayed Splenic Rupture After a Percutaneous Transsplenic Approach to Treat Portal Vein Occlusion.

Abstract

PURPOSE:

To report a case of delayed splenic rupture after percutaneous transsplenic portal vein stent deployment.

CASE REPORT:

A 72-year-old male patient presented at a medical center with abdominal pain and reduced liver function according to laboratory tests. Due to a history of right hemihepatectomy and left portal vein occlusion, the percutaneous transhepatic approach was considered inappropriate. Instead, percutaneous transsplenic access was selected as a suitable procedure for portal vein catheterization. Eight days following the procedure, the patient developed abdominal pain, and a computed tomography scan showed a small splenic pseudoaneurysm that was underappreciated at the time. Patient suffered acute splenic rupture 32 days post-procedure. Subsequent embolization was performed, achieving complete hemostasis.

CONCLUSION:

The transsplenic approach should be considered when the transhepatic or transjugular approach is unfeasible or difficult to implement. A careful plugging of the puncture tract is necessary to prevent or minimize hemorrhage from the splenic access tract. In addition, careful serial follow-up computed tomography should be used to evaluate the splenic puncture tract.

• Authors: Jung Han Hwang, Jeong Ho Kim, Suyoung Park, Ki Hyun Lee
• Journal: Vascular and endovascular surgery (Vasc Endovascular Surg) Vol. 55 Issue 6 Pg. 623-626 (Aug 2021) ISSN: 1938-9116 [Electronic] United States
• PMID: 33602050 (Publication Type: Case Reports)

Topics

• Aged
• Computed Tomography Angiography
• Constriction, Pathologic
• Embolization, Therapeutic
• Endovascular Procedures (adverse effects, instrumentation)
• Humans
• Male
• Phlebography
• Portal Vein (diagnostic imaging, physiopathology)
• Splenic Rupture (diagnostic imaging, etiology, therapy)
• Stents
• Time Factors
• Treatment Outcome
• Vascular Diseases (diagnostic imaging, physiopathology, therapy)