Xu GY, Gong YH, Wang Y, Han XL, Hao C, Xu L. Splenic artery aneurysm with double-rupture phenomenon and circulatory collapse following anesthesia induction: A case report. World J Clin Oncol 2025; 16(4): 100957 [DOI: 10.5306/wjco.v16.i4.100957]
Corresponding Author of This Article
Ya-Hong Gong, MD, Associate Professor, Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China. yh2087@163.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Oncol. Apr 24, 2025; 16(4): 100957 Published online Apr 24, 2025. doi: 10.5306/wjco.v16.i4.100957
Splenic artery aneurysm with double-rupture phenomenon and circulatory collapse following anesthesia induction: A case report
Guang-Yan Xu, Ya-Hong Gong, Yi Wang, Xian-Lin Han, Chang Hao, Li Xu
Guang-Yan Xu, Ya-Hong Gong, Yi Wang, Li Xu, Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
Xian-Lin Han, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
Chang Hao, Department of Anesthesiology and Perioperative Medicine, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen 518067, Guangdong Province, China
Author contributions: Xu GY, Gong YH, Hao C, and Xu L drafted the manuscript; Han XL was the surgeon in charge of the surgery; Gong YH and Wang Y were anesthesiologists in charge of anesthesia; Gong YH takes responsibility for the paper as a whole. All authors critically revised the manuscript for important intellectual content, approved the final version of the manuscript, and agreed to be accountable for the integrity of the work. All authors accept responsibility for the decision to submit for publication.
Supported by National High Level Hospital Clinical Research Funding, No. 2022-PUMCH-B-119.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ya-Hong Gong, MD, Associate Professor, Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China. yh2087@163.com
Received: September 1, 2024 Revised: January 13, 2025 Accepted: March 8, 2025 Published online: April 24, 2025 Processing time: 205 Days and 18.3 Hours
Abstract
BACKGROUND
Splenic artery aneurysm (SAA) rupture is a rare, life-threatening condition characterized by acute intra-abdominal hemorrhage and hemodynamic instability. Ruptured SAAs may exhibit a biphasic and relatively slow clinical progression, commonly referred to as the “double-rupture phenomenon”. The reported incidence of the double-rupture phenomenon ranges 12%-21% in patients with ruptured SAAs, potentially due to variations in intra-abdominal pressure. Following anesthesia induction, muscle relaxation can decrease intra-abdominal pressure, potentially triggering the double-rupture phenomenon and leading to circulatory collapse.
CASE SUMMARY
A 61-year-old female presented to the Department of Emergency with upper abdominal pain, abdominal distension, dizziness, and vomiting. Her vital signs were initially stable. Physical examination revealed abdominal tenderness and positive-shifting dullness. Abdominal contrast-enhanced computed tomography revealed cirrhosis, severe portal hypertension, and splenomegaly. Acute rupture was suggested by a hematoma on the upper left side outside the SAA. Surgeons deemed intravascular intervention challenging and open splenectomy inevitable. Circulatory collapse occurred after anesthesia induction, likely due to a double rupture of the SAA. This double-rupture phenomenon may have resulted from an initial rupture of the SAA into the omental bursa, forming a hematoma that exerted a tamponade effect. A second rupture into the peritoneal cavity may have been triggered by decreased intra-abdominal pressure following anesthesia induction. The patient’s life was saved through early, coordinated, multidisciplinary team collaboration. Following cardiopulmonary resuscitation and emergency splenectomy, she recovered without significant postoperative bleeding or hypoxic encephalopathy.
CONCLUSION
Anesthesia-induced pressure reduction may trigger a second SAA rupture, causing collapse. Early diagnosis and multidisciplinary teamwork improve outcomes. This is a rare and life-threatening case of SAA rupture, which is of great significance to the medical community for understanding and handling such emergencies.
Core Tip: Ruptured splenic artery aneurysm (SAA) exhibits a biphasic and relatively slow clinical progression, referred to as a “double-rupture phenomenon”. Anesthesia induction can decrease the intra-abdominal pressure and lead to a second rupture of the SAA, resulting in circulatory collapse and life-threatening conditions. This report presents a rare case of SAA with a double-rupture phenomenon and circulatory collapse following anesthesia induction. The patient was successfully discharged after cardiopulmonary resuscitation and emergency splenectomy. Managing patients with ruptured SAA poses significant challenges. Early diagnosis and timely multidisciplinary team coordination and collaboration are critical for saving lives in such cases.
