Aneurysm of an anomalous splenic artery arising from splenomesentric trunk: a rare presentation.

To cite: Kandoria A, Kandoria M, Ganju N, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2015-214273 DESCRIPTION A 30-year-old man presented with recurrent episodes of abdominal pain. Ultrasound revealed an aneurysm of the aberrant splenic artery. A CT scan showed a 32×26 mm saccular aneurysm just 3 mm after the origin of the splenic artery from the superior mesenteric artery (SMA) (figure 1). Absence of focal arterial disruption, perivascular inflammation and an irregular aneurysmal wall ruled out pseudo-aneurysm. Detailed work-up for pancreatitis, vasculitis, collagen vascular disease and infection was negative. There was no history of trauma. A selective angiogram was performed for consideration of endovascular intervention (figure 2 and video 1). On selective angiogram of the celiac artery, there was no visualisation of the splenic artery (figure 3A and video 2). The splenic artery aneurysm (SAA) was imaged in multiple planes on selective SMA injections (figure 3B–D). SAAs are the commonest visceral aneurysms, accounting for 70% of all visceral aneurysms. The splenic artery arises from the celiac trunk in more than 85% of patients. It arises from SMA (splenomesenteric trunk) in less than 1% of patients. As a result, SAAs with an anomalous origin from the SMA are extremely rare, with less than 30 cases previously reported in the literature. Rupture of a SAA is associated with significant mortality of between 35% and 100%. All symptomatic aneurysms need repair. Asymptomatic aneurysms greater than 20 mm, and those rapidly growing or present during pregnancy, also need repair. Surgical and transcatheter endovascular interventions have both been described for treatment. An anomalous origin, extremely short (3 mm) proximal segment and tortuous course, Figure 2 Selective angiogram of the superior mesenteric artery (SMA). Showing aneurysm of the aberrant splenic artery, just after its origin from the SMA.