Badellino, Michael M, MD

Good, Meghan L, MD

Lieberman, Jayme D, MD

Sandhu, Rovinder S, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of SurgeryAcute Care Surgical Service Experience withRuptured Visceral Artery AneurysmsJayme D. Lieberman MDLehigh Valley Health Network, Jayme_D.Lieberman@lvhn.orgMeghan L. Good MDLehigh Valley Health Network, Meghan_L.Good@lvhn.orgRovinder S. Sandhu MDLehigh Valley Health Network, Rovinder_S.Sandhu@lvhn.orgMichael M. Badellino MDLehigh Valley Health Network, Michael.Badellino@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/surgeryPart of the Other Medical Specialties Commons, and the Surgery CommonsThis Presentation is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works byan authorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtLieberman, J., Good, M., Sandhu, R., & Badellino, M. (2015, May 22). Acute Care Surgical Service Experience with Ruptured VisceralArtery Aneurysms. Presentation presented at: Schaeffer Research Day, Lehigh Valley Health Network, Allentown, PA.Meghan Good, MD, PGY4 05.22.15 Schaeffer Surgical Society Acute Care Surgical Service Experience with Ruptured Visceral Artery Aneurysms Background ■ Aneurysms of visceral arteries are an uncommon but lethal form of vascular disease  ■ 22% of visceral artery aneurysms present with rupture, with a 25-75% mortality rate  ■ Most of literature consists of case reports  Objective ■ To present our experience of patients with ruptured visceral artery aneurysms (RVAA) over a five month period Methods ■ Retrospective review of prospectively collected data from the Acute Care Surgery Service at LVHN  ■ Study period: 12/2013 - 5/2014   ■ Three patients with RVAA were identified Case #1 ■ HPI: 56yoF found down at home.  Cardiac arrest x3, intubated, on epi. CT revealed hemoperitoneum.  – PMH/PSH: HTN, hypothyroidism, DJD, chronic back pain, endometriosis s/p multiple LOA, chole, appy, eye surgery – Hmeds: percocet, lisinopril, synthroid,cymbalta, flexeril, ultram, tobradex   ■ CT  Case #1 ■ HPI: 56yoF found down at home.  Cardiac arrest x3, intubated, on epi. CT revealed hemoperitoneum.  – PMH/PSH: HTN, hypothyroidism, DJD, chronic back pain, endometriosis s/p multiple LOA, chole, appy, eye surgery – Hmeds: percocet, lisinopril, synthroid,cymbalta, flexeril, ultram, tobradex   ■ CT ■ Hb 6.6, INR 2.2, lactate >20, pH immeasurable, T 94.3 Case #1 ■ Emergent exploratory laparotomy – Splenectomy, distal pancreatectomy, SBR ■ Hospital Course – Hemorrhagic shock/ MODS – Multiple washouts, Wittmann patch, GJ tube, eventual closure  – Septic shock – reopening of laparotomy, SBR, subtotal colectomy, washout with end ileostomy, closure, tracheostomy – d/c to LTACH   Case #2 ■ HPI: 84yoF trauma alert s/p MVC rollover.        c/o abdominal pain and nausea.   – PMH/PSH: Hep C, HTN, DJD, hyperlipidemia – Hmeds: lopressor, lingagliptin, iron, vitamins   ■ Primary Survey intact.  HR 115, BP 112/79 ■ LUQ/LLQ tenderness ■ CT Case #2 ■ Exploratory laparotomy – Mobilization of right colon, packing ■ Arteriogram   Case #2 ■ Exploratory laparotomy – Mobilization of right colon, packing ■ Arteriogram – IR embolization of middle colic a. branch aneurysm ■ Hospital Course – Re-exploration, closure – VDRF, weaned off ventilator – d/c home POD 20   Case #3 ■ HPI: 59yoM found down, intubated in ED for AMS.  MVA 6 months ago, treated for spinal fx’s and DVT.  c/o pain/worsening swelling of LLE.  – PMH/PSH:LLE DVT, ETOH/drug abuse, recent MVA, seizure disorder, bipolar – Hmeds: coumadin, aspirin, keppra, depakote, metoprolol, amitriptyline, geodon, neurontin, vicodin, flomax   ■ LLE compartment syndrome ■ CT Case #3 ■ Hospital day 1 – Emergent LLE fasciotomy – Agram  Case #3 ■ Hospital day 1 – Emergent LLE fasciotomy – Agram - IR embolization SMA branch, spleen ■ POD 1 – CT Case #3 ■ Hospital day 1 – Emergent LLE fasciotomy – Agram - IR embolization SMA branch, spleen ■ POD 1 – CT– hemoperitoneum – Right Hemicolectomy ■ POD 2 – Completion of fasciotomy, L popliteal aneurysm ligation and exclusion, L SFA to PT bypass  – Washout  Case #3 ■ POD3-28 – Multiple abdominal washouts – Ileocolic anastomosis – Abdominal closure – Fasciotomy closure ■ POD 29 – d/c to SNF  Results ■ 56yoF: ruptured splenic a. aneurysm – Distal pancreatectomy, splenectomy  ■ 84yoF: ruptured middle colic a. aneurysm – Embolization of aneurysm ■ 59yoM: contained rupture of SMA aneurysm and ruptured left popliteal a. aneurysm – Bypass and exclusion of popliteal aneurysm – Embolization of SMA aneurysm – R hemicolectomy   Results ■ All patients lived to hospital discharge ■ LOS 20-40 days ■ Total operative procedures 2-13, majority washouts ■ 1 partial colectomy, 1 total colectomy Conclusion ■ RVAA must be considered in patients presenting with hemorrhagic shock. With a multidisciplinary approach and several therapeutic options, including interventional embolization and laparotomy, survival was higher than the literature suggests. These results should prompt further investigation regarding all techniques and team oriented approaches to treat RVAA. References available upon request Meghan_L.Good@lvhn.org 

Acute Care Surgical Service Experience with Ruptured Visceral Artery Aneurysms

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1704&context=surgery

Acute Care Surgical Service Experience with Ruptured Visceral Artery Aneurysms

Abstract

Similar works

Full text

Available Versions

Lehigh Valley Health Network: LVHN Scholarly Works