A 67-Year-Old Man With Hypertension Presenting With Spontaneous Rupture of a Large Splenic Artery Aneurysm Associated With Thrombus

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BACKGROUND Splenic artery aneurysm (SAA) represents the most frequent form of visceral artery aneurysm, yet it remains a rare entity overall. While most cases are incidentally detected, rupture is a potentially catastrophic event with high mortality. Management strategies are relatively well established for unruptured or ruptured aneurysms, with options ranging from endovascular treatment to surgical resection. However, the optimal approach in the exceptional situation of a ruptured aneurysm that has spontaneously thrombosed remains poorly defined, creating a therapeutic dilemma for clinicians. CASE REPORT We present the case of a 67-year-old male with a history of hypertension and prior stroke who was admitted with sudden onset of severe abdominal pain, hypotension, and circulatory collapse. Emergency imaging revealed a ruptured SAA associated with intra-abdominal bleeding. Remarkably, subsequent evaluation demonstrated that the aneurysm lumen had undergone spontaneous thrombosis following rupture, resulting in temporary hemodynamic stabilization. After initial resuscitation and close monitoring in intensive care, a decision was made to proceed with an elective splenopancreatectomy and en-bloc resection of the aneurysm, considering the high risk of rebleeding and associated complications. The surgical procedure was successful, and the patient's postoperative course was uneventful, with full recovery achieved. CONCLUSIONS This case highlights the complexity of managing ruptured SAA complicated by spontaneous thrombosis. Although spontaneous occlusion may provide temporary stability, it should not be regarded as definitive treatment. A tailored, multidisciplinary approach is crucial, and timely surgical intervention remains advisable to prevent delayed rupture or other adverse outcomes.

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