Spontaneous Total Regression Of Post-acute Pancreatitis Splenic Artery Pseudoaneurysm: A Case Report And Review Of The Literature
Ben Ismail, I., Zaafouri, E. B., Sghaier, M., Rebii, S., & Zoghlami, A. (2024). Spontaneous total regression of post-acute pancreatitis splenic artery pseudoaneurysm: A case report and review of the literature. International journal of surgery case reports, 122, 110102. https://doi.org/10.1016/j.ijscr.2024.110102
View Original Source →Abstract
INTRODUCTION: Splenic artery pseudoaneurysms (SAP) are uncommon but significant vascular complications frequently associated with pancreatitis. These lesions carry a substantial risk of rupture and subsequent life-threatening hemorrhage. Standard treatment typically involves surgical or endovascular intervention to prevent such catastrophic outcomes. However, this case report documents a rare instance of spontaneous regression of a SAP following severe pancreatitis, challenging the established treatment protocols and highlighting the potential for conservative management under specific conditions. CASE PRESENTATION: A 65-year-old male with a past history of acute biliary pancreatitis secondary to gallstones, which was treated with laparoscopic cholecystectomy, presented with severe abdominal pain and a significant drop in hemoglobin levels. Imaging revealed acute pancreatitis with multiple pseudocysts and a newly identified 10 mm splenic artery pseudoaneurysm exhibiting recent bleeding. Although arterial embolization was recommended, the patient opted for non-invasive management. Intensive monitoring and conservative treatment were initiated. Over several days, his symptoms improved, and follow-up imaging showed spontaneous thrombosis of the SAP. One month later, a CT scan confirmed the complete resolution of the pseudoaneurysm. DISCUSSION: SAPs are serious complications of pancreatitis, often necessitating urgent intervention due to high rupture risk. This case of spontaneous regression underscores the importance of individualized management strategies. It suggests that conservative treatment may be a viable option for stable patients with resolving pancreatitis, although such cases are rare and require careful monitoring. CONCLUSION: While the primary approach to managing SAP remains interventional due to the high risk of rupture, this case highlights the potential for spontaneous regression in select circumstances. It underscores the need for personalized treatment plans.
Case Details
Disease Location
Splenic artery
Personal Characteristics
65-year-old man with a past history of acute biliary pancreatitis secondary to gallstones, treated with laparoscopic cholecystectomy
Clinical Characteristics
After two years of follow-up, he presented for a second severe episode of acute biliary pancreatitis. CT scan of the abdomen showed an e balthazar stage acute pancreatitis with a ctsi score of 4 with a large inflammatory mass of the lesser omental sac and of the transverse mesocolon with multiple fluid collections and pseudo-cysts in the isthmic and corporeo-caudal pancreas. The patient was placed in icu with IV fluids and analgesics. An emergency CT scan was performed, including arterial phase imaging, which clearly showed the appearance of a 10 mm contrast-enhancing mass arising from the splenic artery consistent with a splenic artery pseudoaneurysm with features of recent bleeding in the corporeo-caudal pseudocyst
Remission Characteristics
On the seventh day of the discovery of the splenic pseudoaneurysm, a follow-up CT scan was performed, revealing a spontaneous thrombosis of the pseudoaneurysm with no active bleeding. One month post-initial diagnosis, another CT scan showed complete resolution of the splenic artery pseudoaneurysm
Treatment & Mechanisms
Proposed Remission Mechanisms
The spontaneous regression observed could be attributed to several factors including mainly the resolution of inflame- mation in the surrounding pancreatic tissues.
Clinical Treatment
IV fluids and analgesics
Non-Clinical Treatment
None reported