A liver transplant was performed in a woman, aged 41 years, with advanced primary biliary cirrhosis. Prior to surgery, her investigations included a contrast-enhanced computed tomography (CT) scan of the abdomen. Good views were obtained of the splenic artery and no abnormalities were detected (Fig. 1). On the sixth day after surgery, she developed abdominal pain and became hypotensive. A repeat CT scan showed a splenic artery aneurysm, 1.8 cm in diameter, in the mid-portion of the splenic artery (Fig. 2). The aneurysm was surrounded by tissue with a density consistent with a blood clot (arrow). Angiography was performed and the aneurysm was treated by transcatheter coil embolization. Subsequent CT scans after 3 and 6 months showed that the size of the aneurysm was stable.
Incidental splenic artery aneurysms can be found at angiography in approximately 1% of patients. Most of these aneurysms were located in the middle third (20%) and distal third (75%) of the splenic artery. Aneurysms are more common in women than in men, particularly those women who have had multiple pregnancies. The prevalence of splenic artery aneurysms in patients with cirrhosis varies widely in different studies but may be approximately 10%. Aneurysms are more common in patients with wide splenic arteries, suggesting a relationship between aneurysm formation and arterial flow. The above case records the development of a splenic artery aneurysm after liver transplantation. Seven similar cases have been reported previously, three with aneurysm rupture within 8 days of transplantation and four who developed aneurysms after months or years. Although reasons for the development of splenic artery aneurysms after transplantation remain unclear, one possible factor is an increase in splenic artery blood flow associated with a reduction in portal vein resistance. In general, the risk of rupture of splenic artery aneurysms is low but it is uncertain whether this also applies to aneurysms in the setting of cirrhosis and liver transplantation.
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