Splenic artery pseudoaneurysm following chemotherapy in a patient with pancreatic cancer: a case report
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CASE REPORT
Splenic artery pseudoaneurysm following chemotherapy in a patient with pancreatic cancer: a case report Kenei Furukawa1 · Hiroaki Shiba1 · Yoshihiro Shirai1 · Yusuke Nagata2 · Masayuki Saruta2 · Katsuhiko Yanaga1 Received: 5 March 2020 / Accepted: 20 May 2020 © Japanese Society of Gastroenterology 2020
Abstract A 48-year-old man presented with epigastralgia and back pain. Radiological evaluation revealed a pancreatic tail tumor with contrast enhancement and an intratumoral fluid component involving the splenic artery and invading the left kidney. Endoscopic ultrasound-guided fine-needle aspiration biopsy revealed an adenocarcinoma, and based on invasion of the left kidney, the patient was diagnosed with unresectable pancreatic cancer with suspected peritoneal dissemination. Radiological evaluation performed after the administration of eight courses of gemcitabine combined with nab-paclitaxel revealed stable disease without distant metastases or peritoneal dissemination. We planned to perform radical resection; however, the patient developed a pseudoaneurysm of the splenic artery preoperatively and initially underwent preoperative coil embolization, followed by radical resection (distal pancreatectomy with combined left nephrectomy and partial resection of the colon and stomach), 11 days after embolization. Histopathological examination of the resected specimen confirmed R0 resection, and the splenic artery pseudoaneurysm associated with pancreatic cancer was attributed to tumor invasion of this vessel. He showed satisfactory postoperative recovery and was discharged on the 24th day after surgery with administration of S-1 adjuvant chemotherapy. Keywords Splenic artery pseudoaneurysm · Chemotherapy · Pancreatic cancer
Introduction Systemic chemotherapy is the standard treatment for unresectable pancreatic cancer. Several recent studies have reported the effectiveness of conversion surgery after chemotherapy for initially unresectable pancreatic cancer [1, 2]. The optimal duration of treatment before surgery is controversial. Satoi et al. reported that conversion surgery was effective for patients who received nonsurgical anticancer treatment for more than 240 days [2]. However, potential adverse effects, such as treatment-associated toxicity and cholangitis secondary to obstructive jaundice observed during preoperative therapy require close attention and appropriate management [3]. * Kenei Furukawa k‑[email protected] 1
Department of Surgery, The Jikei University School of Medicine, 3‑25‑8, Nishi‑Shinbashi, Minato‑ku, Tokyo 105‑8461, Japan
Department of Gastroenterology and Hepatology, The Jikei University School of Medicine, Tokyo, Japan
2
We report a case of splenic artery pseudoaneurysm that developed before conversion surgery for pancreatic cancer.
Case report A 48-year-old man visited a local hospital with epigastralgia and back pain. Abdominal computed tomography (CT) revealed a pancreatic tumor, and he was referred to our hospital for further investigation of this lesion. The pat
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