Multiple Splenic Artery Aneurysms Secondary to Extra Hepatic Portal Vein Obstruction

Abstract

A 14 year old girl presented with vague abdominal pain, recurrent, well tolerated haematemesis and feeling of presence of a lump in the abdomen. Her abdominal examination revealed gross splenomegaly. The laboratory tests, haematological counts, liver enzymes, platelet counts and the international normalized ratio were within the normal limits. Upper gastrointestinal endoscopy showed grade II oesophageal varices. Ultrasonography showed that the portal vein was replaced by multiple, dilated, collateral venous channels around the porta, with collaterals around the pancreas and splenic hilum. There was splenomegaly with a suspicious aneurysm of the splenic artery at the hilum. She was recommended Computed Tomography (CT) angiography, as it was difficult to differentiate aneurysm from collaterals at the splenic hilum on ultrasonography. CT angiography revealed multiple aneurysms in the main splenic artery, at the splenic hilum and at intra parenchymal branches, with largest being seen at the splenic hilum, which measured 18 x 15mm [Table/Fig-1A and B]. [Table/Fig-1A and B]: CT angiography axial section in 14 year old girl showing tortuous splenic artery with large aneurysm in the distal part of the splenic artery (arrow) and another smaller one in the intra parenchymal branch (arrow head). Portovenous phase CT showed multiple dilated venous collaterals replacing the main portal vein with multiple collaterals around the pancreatic head and the splenic hilum. There was gross splenomegaly [Table/Fig-1C and D]. [Table/Fig-1C and D]: 3D volume rendered CT angiography image better depicting the SAA (arrow) and small aneurysms in intraparenchymal branches (arrow heads). The aneurysms were indistinguishable from the dilated collaterals on portovenous phase CT. A diagnosis of extra hepatic portal vein obstruction with splenomegaly and multiple splenic aneurysms was made. Splenectomy, aneurysmectomy and a splenorenal shunt were performed. The post operative period was uneventful.