A Rare Case of Splenic Artery Aneurysm With Unusual Combination of Pancytopenia and Massive Splenomegaly in a Tertiary Care Hospital

Aneurysms of the splenic artery leading to extrahepatic portal hypertension are sporadic and infrequently encountered. They typically manifest as a consequence of thrombus or embolus formation. A splenic artery aneurysm (SAA) represents a localized expansion in the diameter of the splenic artery and is one of the most prevalent forms of visceral artery aneurysms. This artery dilation is primarily attributed to pancreatitis, trauma, or atherosclerosis, commonly affecting elderly patients. Patients affected by this condition typically remain asymptomatic, except for an audible bruit over the aneurysm site, unless a rupture occurs. In the event of a rupture, early indicators include abdominal pain, hemoperitoneum, and a positive Kerr sign, all indicative of SAA rupture. Most SAAs are incidentally discovered, with CT angiography being the preferred diagnostic tool. We present the case of a 38-year-old female (gravida 1, para 1) with a previous full-term normal delivery, who presented to a rural tertiary care hospital with a two-week history of left-sided abdominal pain. A CT scan of the abdomen revealed a solitary aneurysm in the distal portion of the splenic artery, accompanied by perisplenic fluid collection resulting in splenomegaly. Given the critical risk of rupture, which can result in life-threatening bleeding, prompt and accurate diagnosis assumes paramount significance. It is worth noting that the diagnosis of SAA often occurs incidentally due to its asymptomatic nature in its early stages. We document this unique occurrence of extrahepatic SAA contributing to pancytopenia, portal hypertension, and extensive splenomegaly to provide valuable insights for medical professionals in recognizing and managing such presentations. This awareness can help prevent unnecessary diagnostic and therapeutic interventions.