Abstract
BackgroundSplenic artery aneurysms are the commonest visceral and third most common abdominal artery aneurysms, having a strong association with both pregnancy and multiparity. Here we report possibly the first case of a giant splenic artery aneurysm in association with a smaller portal vein aneurysm, in a woman who had never conceived, leading to non-cirrhotic portal hypertension.Case presentationA 40-year-old Pakistani Asian woman who had no evidence of liver cirrhosis presented in April 2016 for a diagnostic workup of ascites, massive splenomegaly, and pancytopenia. An abdominal ultrasound followed by computed tomography angiography showed a giant aneurysm in her splenic artery and another smaller one in her portal vein.She underwent splenectomy and excision of the splenic artery aneurysm. Surgical findings included a giant splenic artery aneurysm pressing on her portal vein and causing its aneurysmal dilatation. On her first review in July 2016, she was generally in good health, ascites had subsided, and her full blood count was normal. Her portal vein aneurysmal dilatation, which was presumed to be secondary to the pressure effect from the splenic artery aneurysm, had shrunken remarkably in size.ConclusionA giant splenic artery aneurysm can cause non-cirrhotic portal hypertension and should be treated with splenectomy and aneurysmectomy.
Highlights
Splenic artery aneurysms are the commonest visceral and third most common abdominal artery aneurysms, having a strong association with both pregnancy and multiparity
Non-cirrhotic portal hypertension secondary to Splenic artery aneurysm (SAA) has very rarely been described in the medical literature and this case report is one such case
As portal hypertension is the most common cause for portal vein aneurysmal dilatation, we assumed that the portal vein aneurysmal dilatation in our case was secondary to non-cirrhotic portal hypertension and as a result of the pressure effect caused by the large SAA
Summary
Splenic artery aneurysms (SAAs) are the commonest of all visceral aneurysms accounting for approximately 60 % of the cases [1, 2]. Her bone marrow examination was consistent with features of hypersplenism/peripheral destruction and reduced iron stores An ultrasound of her abdomen and pelvis was notable for ascites, enlarged spleen measuring 22 cm with multiple splenic infarcts, dilated portal vein, and a large aneurysm in her splenic artery. A repeat upper GI endoscopy was notable for three columns of large esophageal and a bunch of fundal varices, which were band ligated under endoscopic guidance Both computed tomography (CT) of her abdomen and pelvis followed by CT angiography of her abdominal vessels showed a giant saccular splenic artery mid segment aneurysm measuring 12.2×9.4 cm with peripheral mural thrombosis and calcification, a smaller splenic artery distal segment aneurysm, and gross splenomegaly with infarcts. The CT angiography showed a massive SAA which was leaking intermittently with mural calcification and thrombosis
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