Removal of a Splenic Artery with a Large Aneurysm Adhered to the Pancreas Without Pancreatectomy: Report of a Case

Abstract

Splenic artery aneurysms account for about 60% of all visceral aneurysms. The treatment include surgical procedures that sometimes require pancreatectomy. This report describes the case of a 64-year-old woman who had multiple splenic artery aneurysms with various visceral artery dilatations. Because there was no obvious cause for the splenic artery aneurysms and other arterial abnormalities, we suspected an anomaly of the connective tissue, which was subsequently confirmed by a postoperative histopathologic examination. Thus, we decided to remove the whole splenic artery, to eliminate the formation of any further aneurysms, as well as a splenectomy. During the operation, the largest splenic artery aneurysm was found to be adhered to the pancreas too tightly to ablate. It initially appeared that pancreatectomy would be necessary, but considering the associated risk of postoperative complications, we tried to avoid this. Thus, we cut open the aneurysm and excised it, leaving the anterior wall which was adhered to the pancreas. Our procedure proved the best way to preserve the pancreas and eliminate further aneurysmal formation.

Giant splenic artery aneurysm treated surgically with spleen and pancreas preservation

“… 10 , 13 Moreover, usually tight adhesion of the aneurysm to the distal pancreas makes aneurysm inseparable from the pancreatic tissue, which requires en-bloc resection of the aneurysm and distal pancreas. 10 , 12 , 14 …”

Spleno-pancreatectomy En Bloc with Parcelar Gastrectomy for Splenic Artery Aneurysm – A Case Report and Literature Review

“…When it comes to the necessity of associating a pancreatic resection, it seems that this gesture is almost always imposed when the aneurysmal dilatation is embedded within the pancreatic parenchyma (25), as in our case. Once the decision of performing a concomitant pancreatic resection is made, the surgeon should be aware of the significantly increased risk of developing acute postoperative complications such as pancreatic fistulas or long-term complications such as diabetes mellitus (26). However, due to improvements in the surgical technique and postoperative management of cases necessitating pancreatic resections, the perioperative morbidity rate significantly decreased in the last decades conducting to the safe association of pancreatic resections for various pathological processes involving these viscera (26,27,28).…”

Giant Aneurysm of the Splenic Artery Adherent to the Pancreas with Splenic Infarct: Report of a Case

“…Excision of the aneurysm is recommended when the lesion is separable from the pancreas, otherwise distal pancreatectomy including aneurysm is almost always necessary because of involvement of the tail of the pancreas (11). KITAMURA et al reported a case of successful aneurysm excision without pancreatectomy, despite the fact that the aneurysm (23 mm) was tightly adherent to the pancreas (12). For aneurysms located in the distal third, resection with splenectomy is most often performed.…”