Introduction: Large splenic artery aneurysms are rare, but comprise 60% of all visceral artery aneurysms. Most are found incidentally and rupture in the non-pregnant patient carries an approximate 25% mortality rate. Historically these have been managed with an open surgical approach for resection.
Methods: We present the case of a 45 year old male with a recent episode of bacterial endocarditis with an incidental finding of a large 6 cm splenic artery aneurysm. There was noted to be splenic vein occlusion and multiple splenic infarcts versus abscesses on pre-operative imaging. There were concerns this represented a mycotic aneurysm. He underwent a laparoscopic en bloc splenic artery aneurysm resection with splenectomy and distal pancreatectomy with the use of pre-operative prophylactic balloon catheter aneurysm occlusion.
Results: His large splenic artery aneurysm was adjacent to the splenic hilum. Due to the splenic vein occlusion there were large collateral vessels complicating the dissection. Additionally, the aneurysm had dense adhesions to the tail of the pancreas from a desmoplastic reaction. To safely remove the aneurysm a distal pancreatectomy was included with resection of the spleen. The specimen was successfully removed intact using the laparoscopic approach. The patient had an uneventful recovery and was discharged home on post-operative day two. Final pathology revealed no evidence of bacterial etiology.
Conclusion: Laparoscopic distal pancreatectomy with splenectomy is an appropriate minimally invasive option for the treatment of splenic artery aneurysms. This video demonstrates the technical challenges and management options for successfully completing a distal pancreatectomy and splenectomy in the face of a splenic artery aneurysm.
Session: Podium Video Presentation
Program Number: V022
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