12 April 2004
In the late Spring of 2003, I began having mild abdominal symptoms. It felt like an odd sort of pressure at times in the left side of my abdomen. It was bothersome enough that I went to my family doctor and expressed concern. Because I was also having some Irritable Bowel Syndrome symptoms, she suggested a colonoscopy, which was done in August. The colonoscopy was normal but the symptoms continued. I persisted in expressing my concerns to my physician. We discussed the possibilities of a hernia or tumor or adhesions (from a previous laparoscopic gallbladder surgery.) I had an abdominal ultrasound in October, which was normal. The odd pressure feelings continued. In late October I had a CT scan, which revealed a 1.1 cm splenic artery aneurysm. My family doctor did not seem alarmed and suggested that I simply have another CT scan in 6-12 months to see if it was getting any larger. She didn't think the SAA was a real concern unless I was planning to become pregnant (I'm not.) She also didn't think my abdominal symptoms could be related to the SAA. I was still concerned about them, however, and wondered if the cause might be endometriosis. I asked for a referral to an ob-gyn. The referral to the ob-gyn, and his subsequent referral to a surgeon, are the best things that could have happened to me.
The ob-gyn, Dr. Patrick Heffron, did a vaginal ultrasound and found no endometriosis. But then he sat me down in his office and talked to me very seriously about splenic artery aneurysms and what we know and what we don't know about them. He told me that most physicians are not familiar with the treatment of SAA's, having usually seen them only after rupture or at autopsy. That got my attention. He referred me to a surgeon for an evaluation. The surgeon he recommended was unfortunately unavailable and I instead saw his partner. The partner suggested monitoring the SAA in 6 months.
By this time I was reading everything I could about SAA's and trying to understand the little information I could find about treating them in a non-emergency situation and evaluating the possibility for rupture.
A few weeks later Dr. Patrick Heffron called me and said he had received the notes from the surgeon I visited, he was not satisfied, and he would like me to get a second opinion from another surgeon. I will be forever grateful to Dr. Heffron for his persistence in encouraging me to pursue other medical opinions regarding my diagnosis and treatment options.
He recommended Dr. David Lauter, a surgeon with extensive vascular experience. I met with Dr. Lauter and we discussed my case in detail. He ordered another ultrasound so that we could see if the aneurysm had gotten larger since the CT scan (it hadn't.) Then Dr. Lauter and I discussed the pros and cons of treatment options, which included leaving the SAA in place and monitoring it through frequent ultrasounds/CT scans, or scheduling surgery to remove it.
Ultimately, I decided the mortality risk of a burst SAA was too high to live with on a daily basis. The fact that I was feeling unexplained abdominal symptoms was also a factor in my decision. Dr. Lauter explained the surgical procedure, which would involve clipping off the artery on either side of the aneurysm and could likely result in a splenectomy (my SAA was located very close to the spleen, which increased the risk of losing the spleen entirely.)
Dr. Lauter referred me to an infectious disease doctor, Dr. Edward Leonard, who talked to me about the consequences of splenectomy and gave me three immunizations (Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae.) I was scheduled for surgery three weeks later and was fortunate to have the time to prepare emotionally and physically for the operation and recovery time.
On 2-4-04 my splenic artery aneurysm was successfully excised. Dr. Lauter performed a laparoscopic surgery: he removed the aneurysm, clipped off the artery, and was even able to save part of my spleen! When he clipped off the main artery, he watched the spleen to see if it was receiving enough blood supply from other blood vessels. The top 2/3 of the spleen turned dark, so he removed that and left a pink and healthy 1/3 spleen. I am very lucky to have emerged from surgery with a functioning partial spleen. Interestingly, Dr. Lauter told me later that the SAA was inflamed, which may have accounted for the presence of abdominal symptoms.
I spent two nights in the hospital and was home on the third day. I don't handle pain medication well so was coping with just Tylenol by day 4. I moved pretty slowly for a week but got steadily stronger and was able to return to work after 2 -1/2 weeks. I saw the surgeon for a post-op check at 4 weeks and he felt I was healing very well. I saw the infectious disease doctor again and we discussed life with a partial spleen (basically normal with some common sense extra precautions ie antibiotics in case of bacterial infection and periodic immunization boosts.)
I am extremely lucky to have been able to deal with my splenic artery aneurysm on a proactive basis, rather than having to deal with it after rupture. I may have had the SAA for a while, in which case I'm thankful that I had two healthy pregnancies and two healthy children many years ago (I'm 48 now.) Fortunately I experienced symptoms and was persistent in seeking a diagnosis. I am lucky that I found my way to Dr. Heffron, the ob-gyn who so strongly advocated for me to seek another surgeon's opinion. And I am extremely lucky to have been referred to my surgeon, Dr. Lauter, whose management of my case was consistently knowledgeable and caring, and whose expertise and skill resulted in the successful excision of the SAA and a partial rather than total splenectomy.
I would like to thank Kurt Bray, whose article posted here helped me immensely as I was searching for support and answers.