Aneurysm of an aberrant splenic artery: An extremely rare occurrence

Abstract

An aberrant splenic artery arising from the superior mesenteric artery, also known as the splenomesenteric trunk, is a rare anatomical variant seen in less than 1% of the population and is more common in females. Aneurysms of the splenic artery originating anomalously from the superior mesenteric artery are extremely rare; only 35 cases of aneurysm of an aberrant splenic artery have been described so far in the English medical literature. We report an extremely rare case of aneurysm of aberrant splenic artery in a 28-year-old man in whom the lesion was detected during routine abdominal scanning and confirmed on computed tomography angiography. Aneurysms of an anomalous splenic artery originating from the superior mesenteric artery are extremely rare; however, they are clinically important because possible rupture could be catastrophic. Exploring these variations is important especially if surgical intervention is contemplated. This could greatly affect the surgical planning and avoid injuries to major arteries and organs intraoperatively. Keywords Aberrant splenic artery, aneurysm, mesenteric arteryAberrant splenic artery arising from superior mesenteric artery (SMA), also known as splenomesenterictrunk, is an anatomical variant seen in less than 1% of population, present more commonly in females 1 ; it's possible embryological basis being interruption of ventral longitudinal anastomosis. Aneurysms of the aberrant splenic artery are seen in a proximial position near the origin of splenic artery from SMA; compared to common location of splenic artery aneurysms in distal-half of splenic artery in patients with orthotopic splenic arteries.2 Proximal anatomical origin coupled with retro-pancreatic location further complicates their management.2,3 Treatment options include surgical resection, laparoscopic techniques and endovascular therapy 4 ; endovascular treatment is safe and minimally invasive with rapid recovery. 3,4A 28-year-old man presented with generalised weakness. Routine ultrasound abdomen revealed anechoic area, in continuation with SMA, showing swirling arterial flow on colour Doppler. Another vessel was arising from this dilatation, coursing towards the spleen. Computed tomography angiography revealed (Figure 1) a 31 Â 27 Â 19 mm saccular aneurysm 18 mm distal to SMA (SMA was normal at its origin). The aneurysm arose off the superior lateral margin of SMA, projecting anterio-laterally, towards right, having a narrow neck which measured 2.4 mm. Enlarged and tortuous splenic artery originated directly from this aneurysm. A hypoplastic celiac artery gave origin to left gastric and common hepatic arteries. Rest of the visceral arteries were normal. There was no history of pancreatitis, trauma or alcohol intake. Considering the large size of the aneurysm, stenting and/or embolisation was advised; however, the patient refused any intervention. He was discharged with the advice of close follow-up.Aneurysms of an aberrant splenic artery are extremely rare, with only 35 such cases been described so far ...

Endovascular coil embolization for an anomalous splenic artery aneurysm with a splenomesenteric trunk

“…Since the first case reported by Ghatan et al 7 in 1967, only 46 cases of an anomalous SAA have been reported. 4 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 A summary of the reported cases is shown in the Table . The mean diameter was 32.5 mm, and 63% of the patients were women.…”

Aneurysm of anomalous splenic artery arising from a splenomesenteric trunk: Review of the literature with a report of a new case

“…The incidence of SA aneurysm is estimated to be around 0.8 %, though the exact number is not known [ 1 ]. We searched through the Medline, PubMed, and Google scholar and were able to find only 44 reported of anomalous SA aneurysms ( Table 1 ) [ 1 , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] ]. The combined rarity of these two conditions explains why so few cases are reported in English medical literature.…”

Splenomesenteric Trunk- Computed Tomographic Study

“…Aberrant splenic artery originating from SMT can also develop aneurysms close to its origin and aneurismal rupture leads to catastrophic consequences. Till date about 36 cases of aberrant splenic artery aneurysms have been reported and successfully treated in the English literature [26,27].…”