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Case Reports
. 2025 Jul 9:2025:7264596.
doi: 10.1155/cris/7264596. eCollection 2025.

A Case of Hemorrhagic Shock for a Ruptured Splenic Aneurysm Treated With REBOA-Assisted Surgery

Chiara D'Alterio  1 , Cristina Carruezzo  1   2 , Armando Raso  3 , Arezia Di Martino  4 , Roberto Santoro  2 , Domenico Giannotti  2
Affiliations
Case Reports

A Case of Hemorrhagic Shock for a Ruptured Splenic Aneurysm Treated With REBOA-Assisted Surgery

Chiara D'Alterio et al. Case Rep Surg. .

Abstract

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique aimed at temporarily interrupting or limiting blood flow through the aorta, which may be used as a bridge until definitive bleeding control by endovascular procedures or surgery. Despite the main current indication for its use is traumatic massive noncompressible torso hemorrhage, its application in end-stage nontraumatic abdominal and pelvic hemorrhage is progressively increasing. Case Presentation: A 42 year-old male patient was brought to our hospital Emergency Department with acute onset of abdominal pain, hypotension, paleness, and diaphoresis. A computed tomography (CT) was performed evidencing a voluminous retroperitoneal hematoma caused by the rupture of an unknown splenic aneurysm. Emergency open splenectomy with resection of the splenic aneurysm and evacuation of the retroperitoneal hematoma was performed, with the assistance of the REBOA technique. The endovascular balloon was positioned in the aorta, proximally to the celiac axis (Zone 1), through a percutaneous femoral access by the interventional radiologist. Intermittent aortic occlusion enabled proximal bleeding control, adequate myocardial and cerebral perfusion, and allowed surgeons to safely and successfully perform splenectomy by resecting the splenic artery at the origin. Conclusion: REBOA provides a rapid and minimally invasive hemodynamic control in severe hemorrhagic settings and its application in the initial management of nontraumatic abdominal hemorrhage should be strongly advised. Further studies with large sample size focusing on nontrauma patients are needed.

Keywords: bleeding control; case report; noncompressible torso hemorrhage; nontraumatic hemorrhage; resuscitative endovascular balloon occlusion of the aorta (REBOA); splenic artery aneurysm.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The REBOA catheter: the white sideport is labeled for balloon inflation, and the red is for arteriography or arterial pressure trasduction.
Figure 2
Figure 2
Contrast enhanced computed tomography scans. The red arrow indicates dissection of the celiac tripod at the origin.
Figure 3
Figure 3
(A) Retroperitoneal pulsating mass of 20 cm diameter, which displaces the stomach anteriorly, the pancreatic body tail antero superiorly and the transverse mesocolon inferiorly. (B) Transverse mesocolon ripped in his inferior fold, with blood spillage.
Figure 4
Figure 4
Preparation of the celiac tripod. Vascular structures are indicated by arrows: left gastric artery (white), hepatic artery (green), splenic artery (black). Splenic artery is isolated on a loop at its origin and on a distal loop.
Figure 5
Figure 5
Control CT after 1 month.
See this image and copyright information in PMC

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