Laparotomic ligation for a splenic artery aneurysm in consideration of arterial blood flow to the pancreas and spleen

Abstract

A 35-year-old woman with no medical history was diagnosed as having an aneurysm of the splenic artery by ultrasonography at a medical check-up. Abdominal angiography showed the aneurysm 2cm in diameter adjacent to the celiac artery and the serpiginous splenic artery. Cardiologists and radiologists consulted us about the case because interventional radiological treatment (IVR) to prevent rupture of the aneurism was difficult. We recommended laparotomic ligation of the proximal splenic artery and intraoperative Doppler echography via a small abdominal incision. After we obtained the informed-consent from the patient, the surgical treatment was performed. When we interrupted the arterial inflow/outflow of the aneurysm, Doppler echography demonstrated arterial blood flow to the pancreas and spleen via the left gastro-epiploic, inferior pancreatic, and dorsal pancreatic arteries. We performed ligation of the splenic artery adjacent to the aneurysm. The patient's postoperative course was uneventful.
Splenic artery aneurysm is a disease that we often encounter. When splenic artery aneurysm is diagnosed, some treatment for it should be done to avoid rupturing. IVR using coils and stent are employed in most cases. In instances in which the difficulty of IVR is strongly expected due to morphorogy, size, and location of the aneurysm like in this case, classical surgical treatments should be considered as arterial ligation.