Presentation of a large jejunal artery aneurysm: Management and review of the literature

• Published in: International journal of surgery case reports 2018-01, Vol.48, p.50-53
• Main Authors: Minaya-Bravo, Ana María, Vera-Mansilla, Cristina, Ruiz-Grande, Fernando
• Format: Article
• Language: English
• Subjects: Aneurysm; Jejunal; Splanchnic aneurysm; Vascular; Visceral aneurysm
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2018.04.042

•JAAs are rare and constitute 1% of all VAAs.•The widespread of diagnostic imaging techniques has increased the number of JAAs diagnosed incidentally.•Visceral artery aneurysms present a rate of rupture of 10–20%. Most of cases of JAAs reported presented rupture at diagnosis.•Symptomatic JAAs and those intact greater than 2 cm must be treated. However, recently the limit of 2 cm has been questioned.•Surgery is especially useful in emergency. On the other hand, embolisation and stents are promising options. Jejunal artery aneurysms (JAAs) constitute less than 1% of all visceral artery aneurysms. They affect mostly men in their fifth decade. In the last years, the widespread of fine cut fine image techniques has increased the number of JAAs diagnosed incidentally. The first case was reported by Levine in 1944. Since then, only a half of hundred cases have been reported. There is a lack of consensus of management of intact JAAs because of the low number of cases published. We present the largest JAA reported in the English literature up to our knowledge. We report a 49 year-old woman with a 4 × 5 cm. intact jejunal artery aneurysm found incidentally in a CT. It rose from the first jejunal branch of superior mesenteric artery without signs of rupture. She underwent elective surgery and the aneurysm was completely excised. Causes of JAAs include congenital, atherosclerosis or degenerative process. Their rate of rupture depends on location, size and underlying disease and it reaches 10–20% for all visceral artery aneurysms. Risk factors of rupture include pregnancy, hyper-flow situations and connective diseases. Most of cases in the literature presented rupture at the time of diagnosis. JAAs are usually treated following the recommendations for visceral artery aneurysms, so intact JAAs greater than 2 cm. and those causing symptoms should be treated. Treatment includes surgery, embolisation or stent. Surgery is the preferred management for emergency settings. JAAs are extremely rare and constitute only 1% of all visceral aneurysms. They are a life-threatening condition.