Giant splenic artery aneurysm: A rare but potentially catastrophic surgical challenge

Introduction: Splenic artery aneurysms are rare but clinically important entities because of their potential for life threatening rupture. They seldom exceed 3cms in size and only a few cases of giant splenic artery aneurysms (more than 10cm size) have been reported until now.

Presentation of case: A 58yr old female presented with painless pulsatile progressively enlarging lump in left upper abdomen. Contrast enhanced computed tomography revealed a 10.6×10.38cm aneurysm arising from distal splenic artery along with a normal pancreas. Surgical treatment in form of complete excision of the aneurysm along with spleen and distal pancreas was performed. Gross examination showed an unruptured 12.7×11.8cm true aneurysm of distal splenic artery. Postoperative course was uneventful.

Discussion: Splenic artery aneurysms are discovered incidentally and the life time risk of rupture is 28% for giant aneurysms. Even with availability of less invasive procedures such as laproscopy or endovascular treatment, open surgery is mostly preferred.

Conclusion: Giant splenic artery aneurysms, although rare, should be considered in patients presenting with left upper abdomen pulsatile masses. Clinical suspicion followed by emergent management is necessary to prevent potentially life threatening complications.