Splenic Aneurysm Rupture in Cirrhotic Patients

To the Editor.—Splenic aneurysm rupture is an uncommon but uniformly lethal cause of hemiperitoneum in cirrhotic patients. Consideration should be given to prophylactic splenic artery ligation and exclusion of the aneurysm or to splenectomy in these patients.

Report of a Case.—A 58-year-old man with decompensated alcoholic cirrhosis (Child's C risk) and two previous episodes of variceal hemorrhage treated by endoscopic injection sclerotherapy rebled massively and was transferred to the University of Michigan Medical Center, Ann Arbor. He was resuscitated with isotonic crystalloid solution and blood products. Intravenous vasopressin and a SengstakenBlakemore tube were used initially to control bleeding. Panvisceral angiography was performed in anticipation of a possible portosystemic shunt. This study demonstrated multiple splenic artery aneurysms, the largest of which measured 2 cm, a replaced right hepatic artery, and massive splenomegaly (Figure).

Four days after admission the patient suddenly became hypotensive and, without evidence of acute gastrointestinal tract