From the Guidelines
Splenic artery aneurysms are a rare but potentially life-threatening complication in patients with pancreatitis, with a significant risk of rupture, particularly in the context of cirrhosis or pregnancy. The incident of splenic artery aneurysm in pancreatitis is not directly addressed in the provided evidence, however, it is known that pancreatitis can cause enzymatic damage to the arterial wall, leading to aneurysm formation 1. Some key points to consider in the management of splenic artery aneurysms include:
- The risk of rupture is higher in larger aneurysms (>2-3 cm) or in patients with a history of rupture 1
- Interventional radiology with trans-catheter embolisation is a mainstay of treatment in cases of rupture, with surgical arterial ligation and splenectomy reserved for failed therapy 1
- Prophylactic intervention may be appropriate in certain cases, such as a known SAA that has previously ruptured or a large aneurysm identified pre-conception 1
- Patients with severe splenomegaly should be monitored for the presence of SAA 1 It is essential to note that the provided evidence focuses on the management of liver diseases in pregnancy, but the principles of managing splenic artery aneurysms can be applied to patients with pancreatitis. In clinical practice, early detection and appropriate management of splenic artery aneurysms are crucial to prevent rupture and reduce mortality rates.
From the Research
Incident of Splenic Artery Aneurysm in Pancreatitis
- The association between splenic artery pseudoaneurysm and pancreatitis has been reported in several studies, with pancreatitis being present in 52% of cases with splenic artery pseudoaneurysm 2.
- The formation of pseudoaneurysm is thought to be due to enzymatic damage to the wall of the splenic artery in the presence of pancreatitis 2.
- The clinical presentation of splenic artery pseudoaneurysm can vary from asymptomatic to hemodynamic instability, and diagnosis can be challenging, especially in the presence of peripancreatic fluid collection or pseudocyst 2, 3.
- Angiography is a useful modality for establishing a definitive diagnosis of splenic artery pseudoaneurysm 2, 3.
- Endovascular management, such as transcatheter embolization or transarterial coil embolization, has been shown to be effective in treating splenic artery pseudoaneurysm, with minimal complications 4, 5, 6.
Complications and Management
- Splenic artery pseudoaneurysm can cause obstructive jaundice, which is a rare but potentially life-threatening complication 4.
- Postembolization syndrome is a common event after endovascular treatment, but it generally resolves without sequelae 5.
- Surgical conversion or open repair are rarely required, and endovascular treatment is often considered the first-line treatment for splenic artery aneurysms 5.
- Hemosuccus pancreatitis, a rare cause of upper gastrointestinal bleeding, can occur due to a ruptured splenic artery pseudoaneurysm, and can be successfully managed via microcoil embolization 6.