Do aneurysms and pseudoaneurysms of the splenic artery require different surgical strategy?

Although aneurysms and pseudoaneurysms of the splenic artery may result in life-threatening hemorrhage, their etiology, mode of presentation, and surgical strategy seem to differ. In an attempt to clarify their management, we reviewed our experience with aneurysms and pseudoaneurysms of the splenic artery.

Between 1977 and 1997, 10 patients were operated on for true aneurysm and 6 for pseudoaneurysm of the splenic artery.

True aneurysms required resection because of rupture (n=7), size (n=2), and anticipated pregnancy (n=1). They remained asymptomatic unless rupture had occurred. Treatment consisted in aneurysmectomy with preservation of the pancreas and spleen when asymptomatic and required splenectomy or splenopancreatectomy when ruptured. Pseudoaneurysms were always associated with chronic pancreatitis and symptoms had lasted from several hours to 4 weeks prior to hospitalization. Caudal splenopancreatectomy was required in all but one case.

To contrast true aneurysms, pseudoaneurysms most often present with massive or intermittent bleeding. While the spleen and pancreas should be preserved when treating asymptomatic true aneurysms, management of ruptured aneurysms and pseudoaneurysms of the splenic artery usually consists of splenectomy or splenopancreatectomy.