A case of a ruptured splenic artery aneurysm appeared 5 months after the resection of the pancreatic body and tail

Abstract

A 26-year-old female visited a nearby clinic because of epigastric pain and was diagnosed as having acute pancreatitis. Abdominal CT scan revealed a cystic tumor 18 mm in diameter at the pancreatic tail. She was referred to our hospital with the diagnosis of pancreatic cystic tumor. Since there were no findings suggestive of malignancy, spleen-preserving resection of the pancreatic body and tail was planned. However, a 1-cm portion of the distal pancreas could not be detached from the spleen. The portion was resected and the stump was sutured. The pathological diagnosis was pancreatic mucinous cystic adenoma. Abdominal CT scan conducted 5 months after the operation revealed ascites, in which the splenic artery could be observed to have penetrated into the spleen. Percutaneous drainage confirmed the diagnosis of late hemorrhage with pancreatic fistula. Emergency angiography showed rupture of a splenic artery aneurysm, and arterial embolization was performed. After the operation, hyperamylasemia persisted for a while but resolved gradually. Splenic infarction was noted in 30% of the spleen, but it was slowly absorbed and disappeared one year after the operation.