Angiographic Imaging of an Aberrant Splenic Artery Origin From the Superior Mesenteric Artery in a Pediatric Liver Transplant Recipient

Objective To describe an exceedingly rare vascular anatomical variant of the splenic artery arising from the superior mesenteric artery (SMA), termed a splenomesenteric trunk, with angiographic imaging in a pediatric patient. Methods Case review of a 6 year‐old boy, status post liver transplantation for biliary atresia, who presented with ongoing hematemesis, melena, portal hypertension and chronic thrombocytopenia from hypersplenism. He underwent portal venous stenting, and we decided to perform a partial splenic embolization to reduce portal pressure and improve platelet counts. CT and angiographic imaging findings are presented, with literature correlation. Results CT 3D and DSA demonstrated the absence of the splenic artery on injection of the celiac trunk. Selective SMA angiography revealed a variant origin of the splenic artery from the SMA, with normal caliber and no aneurysm or stenosis. Conclusion Recognition of this rare vascular variant is essential to avoid procedural complications. This represents, to our knowledge, the first angiographically documented case of a splenomesenteric trunk in a pediatric patient.