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20 April 2004

Pseudoaneurysm of the splenic artery as a diagnostic problem

Michał Edward Nowicki, Dariusz Szymański, Dariusz Kosatka, Janusz Strzelczyk

Case Rep Clin Pract Rev 2004; 5(null):471-473 :: ID: 12347

Abstract

Background: A pseudoaneurysm of the splenic artery is a potentially life-threatening complication of acute pancreatitis. The role of imaging investigations is vital, but sometimes even sophisticated procedures
do not allow to reach a proper diagnosis.Case Report: A 48-year-old woman was operated on twice for the complications of acute pancreatitis. Following the surgery she complained of recurrent left upper quadrant abdominal pain. Computed tomography (CT) revealed a pathological mass in pancreatic tail. Celiac trunk angiography showed normal splenic artery and an accessory spleen. The pain subsided and she was discharged home. A few weeks later she was admitted again with left hypogastric pain. Doppler ultrasound suggested splenic artery aneurysm. Repeated enhanced CT showed a cyst in left kidney and an abscess-like mass in the pancreatic tail. Following conservative treatment she become asymptomatic and sent home pain- free. After the following 5 weeks she was readmitted to the hospital complaining of abdominal pain. At this time elevated blood pressure was noted. Abdominal pains subsided quickly following 10 mg of oral nitrendipine and subsequentblood pressure fall. She was scheduled for laparotomy. Intraoperative ultrasoundconfirmed the presence of pseudoaneurysm. The trunk of splenic artery was ligated, proximally to the left gastroepiploic artery. Following uneventful recovery the patient was discharged home, and was well 18 months later.Conclusions: Despite employing imaging techniques the final diagnosis of splenic artery aneurysm was made mostly upon the clinical symptoms. Ligation of splenic artery is a safe and effective treatment of this uncommon problem.

Keywords: splenic artery pseudoaneurysm, acute pancreatitis, complications

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923