CASE REPORT   

Chirurgia 2020 December;33(6):328-31

DOI: 10.23736/S0394-9508.19.05052-6

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Laparoscopic distal pancreasectomy and resection of retro-pancreatic splenic artery aneurysm: preserving the spleen

Luigi CONTI ¹ *, Gaetano CATTANEO ², Filippo BANCHINI ¹, Flavio C. BODINI ³, Gerardo PALMIERI ⁴, Patrizio CAPELLI ¹

¹ Unit of General, Vascular and Thoracic Surgery, Department of Surgery, G. Da Saliceto Hospital, Piacenza, Italy; ² Unit of Emergency Surgery, Department of Surgery, G. Da Saliceto Hospital, Piacenza, Italy; ³ Unit of Radiology, Department of Radiodiagnostic, G. Da Saliceto Hospital, Piacenza, Italy; ⁴ Unit of General Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy

Splenic aneurysm is often asymptomatic and its diagnosis is incidental. The most severe complication is hemorrhage which requires an emergency surgical intervention. The elective treatment is usually radiological percutaneous embolization or stent grafting. Not all aneurysms are suitable for endovascular management due to localization of the aneurysm; endovascular management requires accurate patients selection and presents some critical points: recanalization, coil migration and distal infarction with abscess formation, and rarely, aneurysm rupture. The available evidence suggests that active treatment should be initiated if the aneurysm is larger than 2 cm in patients at high risk of rupture, such as during pregnancy, patients of childbearing age or following liver transplantation which increase the blood pressure of the splenic vessels. We present the case of 64 year-old-woman incidentally diagnosed with a 3 cm distal third splenic artery aneurysm. Due to localization of the calcified aneurysm and its though adhesion to the tail of the pancreas, the patient underwent to a laparoscopic distal pancreasectomy and resection of the retro-pancreatic aneurysm with preservation of the spleen. The risk associated with laparoscopic resection of the aneurysm is deficient residual blood flow to the spleen, thus leading to splenic infarction and possible evolution into a splenic abscess. In our case the patient had a regular postoperative course with no complications after twelve months follow-up.

KEY WORDS: Spleen; Aneurysm; Laparoscopy