SYNOPSIS: Splenic artery aneurysm (SAA) is an extremely rare vascular pathology. They are clinically important because of their potential for life-threatening rupture. The pathogenesis is not completely understood and its cause remains unknown. The size of SAA rarely exceeds three centimeters and giant SAA (measuring more than 10 centimeters) are extremely rare. We present a case of SAA larger than 12 centimeters, discuss its management and provide relevant literature. To our knowledge, this is the biggest reported SAA and the first documented case of a giant SAA in the Philippines.
CASE SUMMARY: A 58-year-old male with history of essential hypertension and remote history of abdominal trauma was admitted for pain and a pulsatile mass at epigastrium and left upper abdomen. Examination of the abdomen noted pulsatile, nontender, fairly delineated mass at the left hypochondrium, a bruit was appreciated in the area, Traube's space was dull and splenic percussion sign was negative. Laboratory tests showed normal CBC and bleeding parameters, mild azotemia (that improved after hydration) and unremar kable elect rocardiogram
and echocardiogram results. A multislice computed tomography scan with contrast of the abdomen revealed 10.0 x 6.4 centimeters aneurysmal dilatation at the distal third of the splenic artery with intraluminal thrombus formation. The diagnosis was splenic artery aneurysm. Patient underwent splenic aneurysmectomy, splenectomy and di s tal pancreatectomy Gross examinat ion showed an unruptured 12.2x8.0x6.0 centime ters fusiform splenicarteryaneurysm. Histopathology showed hyal inization and focal destruction of aneurysmal wall and this confirmed the diagnosis. Eight months postoperatively, patient was in good health.
CONCLUSION: Early diagnosis and prompt definitive treatment is necessary in its management. This can only be instituted if SAA is considered in the differential diagnosis for pulsatile left hypochondriac mass.