2018 Volume 38 Issue 6 Pages 1025-1030
A 67-year-old woman was admitted to our hospital with the sudden onset of abdominal pain on exertion. Upon arrival, her blood pressure was low at 99/58 mmHg, and abdominal computed tomography revealed a giant splenic artery aneurysm measuring 8 cm in size, with concomitant hemorrhagic ascites/hematoma in the abdominal cavity and retroperitoneum. The umbilical vein showed marked enlargement. Blood tests showed thrombocytopenia and hyperbilirubinemia. Based on the above findings, she was diagnosed as having a ruptured giant splenic artery aneurysm with concomitant decompensated cirrhosis. An emergency laparotomy was planned because we concluded that the aneurysm would be difficult to treat using interventional radiology. Because the perforated splenic artery aneurysm was fixed to the pancreatic tail, we performed a distal pancreatectomy. An intraoperative liver biopsy showed no liver fibrosis. Eventually, she was diagnosed as having idiopathic portal hypertension.
