Blunt abdominal trauma revealing a giant splenic artery aneurysm in a cirrhotic patient: a case report

Introduction and importance: Giant visceral artery aneurysms are exceedingly rare and carry a high risk of rupture. Patients with liver cirrhosis, portal hypertension, or connective tissue disorders are at an increased risk. Timely recognition and surgical intervention are critical to prevent life-threatening complications. Case presentation: A 66-year-old male with hepatitis B-related cirrhosis presented after blunt abdominal trauma. Imaging revealed a well-defined, contrast-enhanced hyperdense lesion in the mid-splenic artery, consistent with a giant aneurysm, along with a small hypodense liver lesion. Due to the aneurysm’s size and rupture risk, surgical resection of the splenic artery aneurysm (SAA) with splenectomy was performed via midline laparotomy, along with a liver wedge biopsy. Pathology confirmed a true SAA with wall calcification and atherosclerosis, an unremarkable spleen, reactive lymph nodes, and mild cirrhosis without malignancy. Postoperatively, the patient recovered well with an improved platelet count, stable liver function, and continued hepatitis B management. Clinical discussion: Giant SAAs may be asymptomatic or detected incidentally, yet they pose a significant rupture risk, particularly in cirrhotic patients. Surgical resection remains the definitive treatment, reducing the risk of catastrophic hemorrhage and improving clinical outcomes. Conclusion: Prompt diagnosis and early surgical management of giant SAAs are essential, especially in high-risk patients, to prevent rupture and achieve favorable postoperative recovery.