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MEE N3195 VI-V Reverses Cirrhosis in 51 Days 51日で肝硬変を治す
Dec. 15, 2022, 07:01 AM, JST

 

The following case is one of the patients. 

 

A 53-year-old Native American woman with a history of liver cirrhosis secondary to alcohol abuse presents to the emergency department after 2 days of diffuse abdominal pain and weakness. The pain was sudden in onset and has progressed relentlessly over the last day, reaching 9 on a scale of 10 in severity. Family members say that her oral intake has been decreased for the last 2 days, but she has had no fever, vomiting, change in bowel habit, blood in stool, or black stool. She has never undergone surgery, and has had one uncomplicated pregnancy.

 

Physical examination
Vital signs:

Blood pressure 82/57 mm Hg
Heart rate 96 beats per minute
Temperature 37.3°C (99.1°F)
Respiratory rate 16 per minute
Oxygen saturation 92% while receiving oxygen at 2 L/minute.

 

The patient is somnolent and has scleral icterus. Her cardiopulmonary examination is normal. Her abdomen is tense, distended, and diffusely tender. She has bilateral +2 pitting edema in her lower extremities. She is oriented to person only and is noted to have asterixis. Her baseline Model for End-stage Liver Disease score is 18 points on a scale of 6 (less ill) to 40 (gravely ill).


Laboratory studies:

Hemoglobin 9.8 g/dL (reference range 11.5–15.5)
Platelet count 100 × 109/L (150–400)
White blood cell count 9.9 × 109/L (3.711.0)
Serum creatinine 1.06 mg/dL (0.58–0.96)
Bilirubin 6.3 mg/dL (0.2–1.3)
International normalized ratio of the prothrombin time 2.15 (0.8–1.2)
Blood urea nitrogen 13 mg/dL (7–21)
Serum albumin 2.7 g/dL (3.9–4.9).

 

Intravenous fluid resuscitation is initiated but the patient remains hypotensive, and on repeat laboratory testing 4 hours later her hemoglobin level has dropped to 7.3 mg/dL.

 

RISK FACTORS FOR SPLENIC ARTERY ANEURYSM
Which of the following is true regarding our patient’s risk of splenic artery aneurysm?

Liver cirrhosis and portal hypertension are her greatest risk factors for it

Female sex and prior pregnancy are her greatest risk factors for it

Being Native American makes it more likely that the patient has splenic artery aneurysm secondary to collagen vascular disease

Her risk of rupture would diminish after receiving a liver transplant

Liver cirrhosis and portal hypertension are her greatest risk factors for splenic artery aneurysm.

 

Risk factors for true aneurysm include hypertension, atherosclerosis, portal hypertension with or without liver cirrhosis, liver transplant, third trimester of pregnancy, and multiparity.1,2,3,4,5 Splenic artery aneurysm is usually diagnosed in the sixth decade. It may be 4 times as common in women, given a hormonal influence.7 Cirrhosis is also associated with massive splenic artery aneurysm (≥ 5 cm).

 

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FIGURE 3 Computed tomography of the abdomen demonstrates splenic aneurysm (large arrow) with active extravasation of contrast (small arrow).
FIGURE 4 Angiography before treatment demonstrates splenic aneurysm (large arrow) with extravasation (small arrow).
FIGURE 5 Angiography after embolization demonstrates coils in the embolized aneurysm without extravasation.

 

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Yours Truly,

 

Lisa Lee
Secretary-General 
MEEOM® WorldWide Health Systems
MEEOM® Precision Medicine
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2022年12月15日 (木曜日)

 

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References
1. Bakhos CT, McIntosh BC, Nukta FA, et al. Staged arterial embolization and surgical resection of a giant splenic artery aneurysm. Ann Vasc Surg 2007; 21:208–210.
2. Abbas MA, Stone WM, Fowl RJ, et al. Splenic artery aneurysms: two decades experience at Mayo Clinic. Ann Vasc Surg 2002; 16:442–449.
3. Al-Habbal Y, Christophi C, Muralidharan V. Aneurysms of the splenic artery—a review. Surgeon 2010; 8:223–231.
4. Akbulut S, Otan E. Management of giant splenic artery aneurysm: comprehensive literature review. Medicine (Baltimore) 2015; 94:e1016.
5. Dave SP, Reis ED, Hossain A, Taub PJ, Kerstein MD, Hollier LH. Splenic artery aneurysm in the 1990s. Ann Vasc Surg 2000; 14:223–229. 
6. Ayoubieh H, Alkhalili E. Another complication of cirrhosis. Cleveland Clinic Journal of Medicine September 2017, 84 (9) 701-706

7. Parrish J, Maxwell C, Beecroft JR. Splenic artery aneurysm in pregnancy. J Obstet Gynaecol Can 2015; 37:816–818.

MEE N3195 VI-V Reverses Cirrhosis in 51 Days 51日で肝硬変を治す

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