Symptomatic Multiple Splenic Artery Aneurysms Complicated by Segmental Portal Hypertension: A Case Report

Abstract Splenic artery aneurysms (SAAs) are the most common type of visceral arterial aneurysms; however, the occurrence of multiple splenic artery aneurysms (MSAAs) remains exceedingly rare. We report the case of a 42-year-old female who presented with persistent, intermittent left upper quadrant pain lasting for two years. Abdominal ultrasonography and contrast-enhanced computed tomography (CT) angiography revealed two splenic artery aneurysms located in the mid-portion closer to the hilum, measuring 2.5 × 2.5 cm and 1.9 cm. Crucially, the vascular imaging demonstrated significant concomitant engorgement of the splenic vein and localised splenic varices, indicative of secondary segmental portal hypertension. Given the persistent symptoms, lesion multiplicity, and complex regional venous involvement, conventional open surgical management was targeted. The patient underwent a successful left subcostal open splenectomy combined with complete aneurysmectomy and resection of the dilated collateral vessels, leading to an uneventful recovery and total resolution of symptoms. This case underscores that clinical decision-making in MSAAs must comprehensively integrate clinical presentation and complex vascular morphology—such as multiplicity and secondary segmental portal hypertension—rather than relying strictly on conventional diameter thresholds to guide definitive intervention.