Page 38 - Virtual Vascular Vol 14
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For the next two days after embolization the patient continued to complain of severe abdom-
inal pain, with a Hb of 7g/dl. His blood pressure was stable at 130/80 mmHg but there was a
persistent tachycardia of 130 beats/min. The abdomen also showed some signs of progressive
enlargement.
It was determined that the embolization was not completely successful, and emergency lapa-
rotomy was performed. There could still be back bleeding into the ruptured sac from collater-
als supplying the spleen from the short gastric arteries.
Distended abdomen at laparotomy. Upon opening the abdomen there was more than 2 li-
tres of blood and blood clots from a free rupture of the aneurysm. A splenectomy was per-
formed. The aneurysm sac was opened and no major arterial inflow from the splenic artery
was evident. Hemostasis was deemed adequate proximally and an aneurysmorrhaphy was
performed.
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