Massive splenic artery aneurysm with aneurysmal dilatation of the portal vein and splenic infarct

Introduction: Aneurysms of the splenic artery are rare but potentially life-threatening problems and the risk of complications increases manifold with their increase in size. The portal vein aneurysms are even rarer with as few as only 200 cases being reported in the surgical literature. The presence of both aneurysms in the same patient has not been previously described. Such cases present a therapeutic challenge. Case Report: A 56-yearold apparently healthy male presented with vague upper abdominal discomfort with fever, headache and a palpable spleen. Evaluation by triple phase computed tomography of the abdomen revealed a large 9×8 cm sized aneurysm in the distal third of the splenic artery with an aneurysmal dilatation of the portal vein about 48 mm at the porta hepatis, splenomegaly with a splenic infarct and multiple gallstones. Laparotomy with distal pancreatosplenectomy, excision of the aneurysm and cholecystectomy were done. Gross evaluation of the specimen revealed a 10 cm aneurysm of the distal splenic artery containing organised thrombus within an infarct at the lower pole of the spleen. Conclusion: Presentation of a massive splenic artery aneurysm in association with a portal Samrat Ray1, Amitabh Yadav1, Samiran Nundy1 Affiliations: 1Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi. Corresponding Author: Samrat Ray, Department of Surgical Gastroenterology and Liver transplantation, Room no 1474, 4th floor, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110060; E-mail: [email protected] Received: 28 July 2016 Accepted: 03 December 2016 Published: 02 January 2017 vein aneurysm is an exceedingly rare clinical phenomenon. Most portal vein aneurysms being asymptomatic may be left alone and followed up periodically. We describe an extremely rare association of coexistent aneurysms of the splenic artery and portal vein which was managed by distal pancreatectomy and splenectomy.