Giant Pseudoaneurysm of the Splenic Artery
Abstract
Context Visceral artery pseudoaneurysms are uncommon. They most commonly affect the splenic artery and are secondary to chronic pancreatitis. Giant pseudoaneurysms (5 cm or larger in size) are rare and, until now, only 19 cases have been reported. Case report A 47-year-old chronic alcoholic and diabetic male presented with upper abdominal pain of 1-month duration without any other significant complaint. Computed tomography was performed which revealed features of chronic pancreatitis along with a splenic artery pseudoaneurysm measuring 7x4 cm in size. As the disease was confined to the body and tail of the pancreas, the patient underwent a distal pancreatectomy and splenectomy along with resection of the pseudoaneurysm with an uneventful postoperative course. Conclusion Splenic artery pseudoaneurysms, especially the giant variety, are uncommon. As they are most commonly secondary to chronic pancreatitis, they are better managed surgically which resolves the pseudoaneurysm as well as its underlying cause (i.e. chronic pancreatitis).
Image: Pseudoaneurysm with a thin wall.
Downloads
References
Tessier DJ, Stone WM, Fowl RJ, Abbas MA, Andrews JC, Bower TC, Gloviczki P. Clinical features and management of splenic artery pseudoaneurysm: case series and cumulative review of literature. J Vasc Surg 2003; 38:969-74. [PMID 14603202]
Goldberg RF, Maley W, Kennedy EP, Yeo CJ, Lavu H. Giant Splenic Artery Pseudoaneurysm. J Gastrointest Surg 2010; Nov 25. [PMID 21108018]
Hsu JT, Yeh CN, Hung CF, Chen HM, Hwang TL, Jan YY, Chen MF. Management and outcome of bleeding pseudoaneurysm associated with chronic pancreatitis. BMC Gastroenterol 2006; 6:3. [PMID 16405731]
Norotsky MC, Rogers FB, Shackford SR. Delayed presentation of splenic artery pseudoaneurysms following blunt abdominal trauma: case reports. J Trauma 1995 ;38:444-7. [PMID 7897735]
Brountzos EN, Vagenas K, Apostolopoulou SC, Panagiotou I, Lymberopoulou D, Kelekis DA. Pancreatitis-associated splenic artery pseudoaneurysm: endovascular treatment with self-expandable stent-grafts. Cardiovasc Intervent Radiol 2003; 26:88-91. [PMID 12491019]
Bresler L, Boissel P, Grosdidier J. Major hemorrhage from pseudocysts and pseudoaneurysms caused by chronic pancreatitis: surgical therapy. World J Surg 1991; 15:649-52. [PMID 1949866]
de Perrot M, Berney T, Buhler L, Delgadillo X, Mentha G, Morel P. Management of bleeding pseudoaneurysms in patients with pancreatitis. Br J Surg 1999; 86:29-32. [PMID 10027355]
Reber PU, Patel AG, Baer HU, Triller J, Buchler MW. Acute hemorrhage in chronic pancreatitis: diagnosis and treatment options including superselective microcoil embolization. Pancreas 1999; 18:399-402. [PMID 10231846]
Lee HS, Park JJ, Kim CD, Ryu HS, Hyun JH. Pseudoaneurysm and splenic infarction in chronic pancreatitis--a case report. J Korean Med Sci 1996; 11:183-7. [PMID 8835768]
LiPuma JP, Sachs PB, Sands MJ, Stuhlmiller S, Herbener TE. Angiography/interventional case of the day. Splenic artery pseudoaneurysm associated with pancreatitis. AJR Am J Roentgenol 1997; 169:259, 262-3. [PMID 9207539]
Waslen T, Wallace K, Burbridge B, Kwauk S. Pseudoaneurysm secondary to pancreatitis presenting as GI bleeding. Abdom Imaging 1998; 23:318-21. [PMID 9569306]
Lin CT, Chiang CW, Hsieh HC. Extrasplenic pseudoaneurysm. The role of color flow Doppler ultrasound in diagnosis. Jpn Heart J 1999; 40:365-8. [PMID 10506858]
De Santis M, Ariosi P, Ferretti A, Casolo A, Manenti A, Romagnoli R. Embolization of giant aneurysm and pseudoaneurysm of the splenic artery. Eur Radiol 2000; 10:1032. [PMID 10879726]
Carr JA, Cho JS, Shepard AD, Nypaver TJ, Reddy DJ. Visceral pseudoaneurysms due to pancreatic pseudocysts: rare but lethal complications of pancreatitis. J Vasc Surg 2000; 32:722-30. [PMID 11013036]
Huang IH, Zuckerman DA, Matthews JB. Occlusion of a giant splenic artery pseudoaneurysm with percutaneous thrombin-collagen injection. J Vasc Surg 2004; 40:574-7. [PMID 15337894]
Hung RK, Loh C, Goldstein L. Selective use of electrolytic detachable and fibered coils to embolize a wide-neck giant splenic artery pseudoaneurysm. J Vasc Surg 2005; 41:889-92. [PMID 15886676]
Michalak M, Huba M, Kirrga M, Slyk P. Giant splenic artery pseudoaneurysm. Pol J Radiol 2005;70:99-102.
Copyright (c) 2011 Vishal Gupta, Sunil Kumar, Pankaj Kumar, Abhijit Chandra
This work is licensed under a Creative Commons Attribution 4.0 International License.
As a member of Publisher International Linking Association, PILA, iMedPub Group’s JOP follows the Creative Commons Attribution License and Scholars Open Access publishing policies. Journal of the Pancreas is the Council Contributor Member of Council of Science Editors (CSE) and following the CSE slogan Education, Ethics, and Evidence for Editors.