Splenic artery aneurysm with extrahepatic portal venous obstruction: A case report. (September 2022)

• Record Type: Journal Article
• Authors: Pathak, Niharika; Poddar, Elisha; Shrestha, Suraj; Kumari, Khusbu; Ranjan, Ritika; Sharma, Deepak; Dahal, Romi; Lakhey, Paleswan Joshi
• Is Part Of: International journal of surgery case reports. Volume 98(2022)
• Publication Date: 2022-09
• Subjects: EHPVO -- hypersplenism -- splenic artery aneurysm -- case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2022.107568
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction and importance: Splenic artery aneurysm is one of the most common visceral aneurysms. Patients are usually asymptomatic. Splenic artery aneurysm if untreated has the potential for rupture and is therefore life-threatening. Its association with extrahepatic portal vein obstruction is rare. Case presentation: A 25-year female was incidentally diagnosed with a splenic artery aneurysm with extrahepatic portal vein obstruction with splenomegaly 8 years back during the 5th month of her second pregnancy. No intervention was done back then. Recently, she presented to the surgical gastroenterology outpatient department with an increasing abdominal mass. On examination, the patient was pale and splenomegaly was present. Hematological reports were suggestive of hypersplenism. The patient underwent splenectomy and aneurysmal resection with a proximal splenorenal shunt as the best course of treatment. Discussion: Due to the rarity of the disease, the management is still challenging and needs further study. Diagnosis can be made clinically with support from imaging modalities. Surgical treatment has a good outcome in such patients. Even with the availability of less invasive procedures such as endovascular treatment, open surgery is preferred. Conclusion: Proximal splenorenal shunt is a well-accepted surgical procedure for extrahepatic portal vein obstruction. Splenectomy and aneurysmal resection can relieve hypersplenism and treat splenic artery aneurysm in patients with isolated splenic artery aneurysm at the splenic hilum. Highlights: SAA with EHPVO is especially common during pregnancy. Albeit rare, due to its high risk of fatality, it is extremely important for clinicians to diagnose and manage it well. Surgery is the best modality of treatment for SAA with EHPVO with hypersplenism.