TALK TO A
Splenic Artery Aneurysm
I was born in 1951 in Spokane, Washington. My dad was in the Air Force So we lived in many places - including 3 1/2 years in Tripoli, Libya. I'm married and have two teenage daughters, and we live in Oceanside, California. I earned a Ph.D. in Immunology from the University of California at Davis and have worked for the past 23 or so years in research and development on various aspects of cancer, autoimmunity, and infectious diseases. I'm currently Director of Development for the Immunomics Operations division of Beckman Coulter Inc. I enjoy reading, music, travel, and sports, especially long distance running. Fun Fact: in 1994 I was an undefeated 5-time champion on Jeopardy!
15 January 2003
My experience was with neither brain nor aortic aneurysm but with an aneurysm of the splenic artery.
I'm 51 years old and in otherwise excellent health. I've been very active - an avid runner who regularly puts in 30 miles or more a week. On Dec. 6th, while changing clothes to go running, I suddenly suffered what felt like a bad abdominal cramp. I tried to walk it off, but soon noticed that I was getting dizzy. I collapsed onto the bed with fading vision. I then noticed that I was also profusely sweating. The pain was more abdominal than thoracic, but combined with the dizziness and cold sweat, I considered that I had 2 1/2 of the 3 major symptoms of a heart attack. I quickly decided to call 911 but found I barely could muster the strength to reach over next to the bed and get the phone. Two minutes earlier I had been preparing to go for an eight mile run, but now I barely had the strength to crawl three feet.
I then had to gather even more strength and stagger/crawl downstairs and unlock the front door. This was because I was home alone, and I knew that the paramedics would knock the door down if it was locked and no one answered. And I did not want my family to spend the next night or two in a house with a broken down front door. I was really angry at this point - I felt that after more than 30 years of faithfully running and keeping fit and trim that I did NOT deserve a heart attack. Not at my age. It was just not fair! The paramedics arrived a few minutes later, and like me they assumed heart attack. Once I got to the ER the EKG and troponin blood test looked normal so it was unlikely to be a heart attack. So then began a long series of ruling things out before a correct diagnosis was finally made.
After heart attack the next thing investigated was perforated duodenal ulcer. The obvious wild swings in blood pressure were suspected of being caused by the "vaso-vagal syndrome" - where the stuff leaking from the ulcer was thought to be irritating the vagus nerve, which in turn was causing the blood pressure to fluctuate. A CAT scan showed that there was no perforation, but it also revealed fluid collected around my pancreas. This caused them to suspect pancreatic cancer, but blood chemistry tests showed my lipases normal, so it wasn't that (whew!).
I could see that some kind of fluid was building up down there because my abdomen was by then visibly swelling. They seemed less alarmed by that than I was because they didn't really know what my gut had looked like before. It hadn't been exactly six-pack abs before, but this four-or-five-months-pregnant look wasn't the real me either. The CAT scan also indicated that the fluid around my pancreas was a high density fluid - which for the first time caused them to mention internal bleeding as a possibility.
They did an ultrasound which showed that fluid was collecting around many organs. Vascular surgeons were brought in, and they performed an abdominal angiogram. They detected some bleeding in the vicinity of the spleen and tried repeatedly for three hours to plug the leak from the inside by inserting a "coil", but in each attempt they could not get it to seat properly. Eventually they gave up and I was sent off for emergency surgery - about 9 hours after I first got to the ER.
After I woke up in Intensive Care I was finally told the correct diagnosis of a burst aneurysm of the splenic artery. The surgeon said that digging through all the blood and huge clots to find the leak was like looking for a needle in a haystack. But he eventually did find it, clamped it off and removed my spleen. He said that it was a close-run thing on the operating table. He said that my good cardiovascular fitness served me well: as the procedure dragged on and things turned for the worse, my heart kept responding well to the stress of the bleeding episodes and the surgery. He said he has seen other guys my age just collapse and die on the table under similar circumstances. Strong heart or no, at the rate I was going down, if they hadn't found and fixed it I would have died in another hour or so. They transfused me with six units of blood, which even so still left my hematocrit and hemoglobin quite low.
The recovery from the surgery has been pretty much uneventful. I lost nearly 20 pounds. My strength has slowly returned as my body has replaced the missing blood. I returned to work four weeks after surgery. And since I am now sans spleen, I am at risk of death from sudden overwhelming infections from certain types of encapsulated gram negative bacteria. I've already been immunized, and I'm going to have to carry penicillin close at hand for the rest of my life. But overall I've been very fortunate: Fortunate that it was a medium-sized artery that burst instead of a big one. Fortunate that I decided to call 911 right away instead of trying to tough it out. Fortunate that it didn't burst 30 minutes later when I would have been out running in some remote part of the park with no one around to help. Fortunate that it didn't burst a month and a half earlier when I was traveling alone in France and would have unable to communicate with anyone and would have been 8000 miles from home when I was discharged from the hospital, weak and in pain. Fortunate that I have every prospect of a full recovery.
Discussion, comments, or questions: Kurt Bray, Ph.D.
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