Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Laparoscopic resection of multiple aneurysms of the gastroepiploic arterial arcade

Abstract

Background

Gastroepiploic arterial aneurysms (GEAA) represent a very rare disorder [1, 2]. The risk of GEAA rupture is high, and it is associated with a high mortality rate [3]. GEAAs are usually identified following rupture or are incidentally diagnosed. In emergency, an open surgical approach to treat GEAAs has been most frequently reported [4]. Alternatively, if the patient is hemodynamically stable, an angiography and embolization can be attempted. Herein we report the case of a patient presenting with two fissurated GEAAs that were successfully excised laparoscopically after failure of the endovascular approach.

Materials and methods

A 83-year-old lady was admitted for acute epigastric pain. Upon admission, her general status was stable. The abdomen was soft and slightly painful at deep palpation in epigastrium, with no sign of peritonism. In her past medical history, she had a transient ischemic attack and atrial fibrillation episodes for which a pacemaker had been placed. Her blood examinations showed a slight anemia (hemoglobin 10.5 g/dl). An abdominal ultrasonography identified two solid, circular, nodules next to the gastric anterior wall that, in a following angio-TC, were diagnosed as two aneurysms of the gastro-epiploic arterial arcade (GEA), one measuring 17 mm × 13 mm, the other 39 mm × 33 mm. Both showed X-ray signs of impending rupture and intraluminal “thrombization”. The patient underwent selective angiography, during which, after an attempt of common hepatic artery catheterism, a dissection and, consequently, an occlusion of the hepatic artery and the celiac trunk unfortunately occurred. Therefore, after a catetherism of the superior mesenteric artery, only a partial and incomplete embolization procedure was possible. As a matter, at the end of the angiographic procedure, reperfusion of the GEA coming from the splenic and hepatic artery was recognized. After 24 h, repeated abdominal CT scan with contrast showed the persistence of the aneurysms with no dimensional changes and the presence of a small active extravasation of contrast from the lateral aneurysm.

Results

Laparoscopic surgical exploration was then warranted. Two voluminous GEA arcade aneurysms, very close to greater curvature of the stomach, were identified. After a cautious visceral dissection, the right and left gastroepiploic arteries were clipped and sectioned. Due to the presence of strength adhesions between the aneurysms and the greater curvature of the stomach, we decided to perform double aneurismectomy “en bloc” with the excision of the adjacent greater gastric curve by using an articulated laparoscopic stapler (Endo GIA™ 60 mm Articulating Medium/Thick Reload with Tri-Staple™ Technology, MEDTRONIC, Minneapolis, US). No intraoperative complications were reported. The patient was discharged in fifth post-operative day.

Conclusions

In case of failure of a non-surgical management of ruptured GEA aneurysms, the laparoscopic resection is a safe and effective procedure.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Byron F, Dipankar M (2008) Hemorrhagic shock secondary to rupture of a right gastroepiploic artery aneurysm: case report and brief review of splanchnic artery aneurysms. Int J Angiol 16:24–26

  2. 2.

    Carmeci C, McClenathan J (2000) Visceral artery aneurysms as seen in a community hospital. Am J Surg 179:486–489

  3. 3.

    Chandran S, Parvaiz A, Karim A, Ghafoor I, Steadman B, Pearce NW et al (2005) Ruptured left gastric artery aneurysm successfully treated by thrombin injection: case report and literature review. Sci World J 5:20–23

  4. 4.

    Ikeda H, Takeo M, Mikami R, Yamamoto M (2015) A case of a huge gastroepiploic arterial aneurysm. J Surg Case Rep. doi:10.1093/jscr/rjv100

Download references

Author information

Correspondence to Dario Tartaglia.

Ethics declarations

Disclosure

Andrea Bertolucci, Dario Tartaglia, Luigi Cobuccio, Christian Galatioto, and Massimo Chiarugi have no conflicts of interest or financial ties to disclose.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (MP4 132938 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Bertolucci, A., Tartaglia, D., Cobuccio, L. et al. Laparoscopic resection of multiple aneurysms of the gastroepiploic arterial arcade. Surg Endosc 32, 1070–1071 (2018). https://doi.org/10.1007/s00464-017-5737-0

Download citation

Keywords

  • Laparoscopy
  • Gastroepiploic aneurysms
  • Angioembolization