Coexisting giant splenic artery and portal vein aneurysms leading to non-cirrhotic portal hypertension: a case report

Abstract

BackgroundSplenic artery aneurysms are the commonest visceral and third most common abdominal artery aneurysms, having a strong association with both pregnancy and multiparity. Here we report possibly the first case of a giant splenic artery aneurysm in association with a smaller portal vein aneurysm, in a woman who had never conceived, leading to non-cirrhotic portal hypertension.Case presentationA 40-year-old Pakistani Asian woman who had no evidence of liver cirrhosis presented in April 2016 for a diagnostic workup of ascites, massive splenomegaly, and pancytopenia. An abdominal ultrasound followed by computed tomography angiography showed a giant aneurysm in her splenic artery and another smaller one in her portal vein.She underwent splenectomy and excision of the splenic artery aneurysm. Surgical findings included a giant splenic artery aneurysm pressing on her portal vein and causing its aneurysmal dilatation. On her first review in July 2016, she was generally in good health, ascites had subsided, and her full blood count was normal. Her portal vein aneurysmal dilatation, which was presumed to be secondary to the pressure effect from the splenic artery aneurysm, had shrunken remarkably in size.ConclusionA giant splenic artery aneurysm can cause non-cirrhotic portal hypertension and should be treated with splenectomy and aneurysmectomy.

A Rare Quadruple Association: Fibromuscular Dysplasia, Giant Splenic Artery Aneurysm, Extrahepatic Portal Hypertension, and Hypersplenism

“…It shows a 4:1 female preponderance, especially affecting the young reproductive age group. 5 , 6 , 10 The common causes of SAA include pregnancy, cirrhotic portal hypertension, trauma, and polyarteritis nodosa. 6 , 10 Fibromuscular dysplasia is a very rare cause of SAA.…”

“… 1 – 3 Splenic aneurysm causing extrahepatic portal hypertension is also extremely rare. 4 – 6 We present the first-ever report of FMD causing giant splenic artery aneurysm with consequent extrahepatic portal hypertension and hypersplenism. Splenectomy and aneurysmectomy can reverse pancytopenia and portal hypertension.…”

Giant Splenic Aneurysm with Arteriovenous (A-V) Shunt, Portal Hypertension, and Ascites

“…The overall incidence in the general population is about 1: 10 000. Giant splenic aneurysms are uncommon [ 3 ], and there are only 9 reported cases with a concomitant AV-shunt present [ 4 – 9 ]. Hyperdynamic conditions due to arteriovenous shunt lead to portal hypertension and ascites.…”

“…Pancreatitis and paralytic ileus were caused by the giant dimensions of the inflamed omentum sac in contact with the adjacent pancreas. The present case is the 10 th to be published [ 4 – 9 ]. Our case is rare and interesting not only due to the extremely high risk of rupture, but also the presence of an A-V shunt leading to portal hypertension, hepatic lesion, and possibly irreversible ascites.…”

“…The aim of this article is to present the management of an extremely rare case of a giant splenic aneurysm with concomitant arteriovenous shunt, portal hypertension, ascites, paralytic ileus, and peritoneal infection due to hemorrhagic pancreatitis. In the current literature, only 9 similar cases are universally registered [ 4 – 9 ].…”