Spontaneous total regression of post-acute pancreatitis splenic artery pseudoaneurysm: A case report and review of the literature

Introduction: Splenic artery pseudoaneurysms (SAP) are uncommon but significant vascular complications frequently associated with pancreatitis. These lesions carry a substantial risk of rupture and subsequent lifethreatening hemorrhage. Standard treatment typically involves surgical or endovascular intervention to prevent such catastrophic outcomes. However, this case report documents a rare instance of spontaneous regression of a SAP following severe pancreatitis, challenging the established treatment protocols and highlighting the potential for conservative management under specific conditions. Case presentation: A 65-year-old male with a past history of acute biliary pancreatitis secondary to gallstones, which was treated with laparoscopic cholecystectomy, presented with severe abdominal pain and a significant drop in hemoglobin levels. Imaging revealed acute pancreatitis with multiple pseudocysts and a newly identified 10 mm splenic artery pseudoaneurysm exhibiting recent bleeding. Although arterial embolization was recommended, the patient opted for non-invasive management. Intensive monitoring and conservative treatment were initiated. Over several days, his symptoms improved, and follow-up imaging showed spontaneous thrombosis of the SAP. One month later, a CT scan confirmed the complete resolution of the pseudoaneurysm. Discussion: SAPs are serious complications of pancreatitis, often necessitating urgent intervention due to high rupture risk. This case of spontaneous regression underscores the importance of individualized management strategies. It suggests that conservative treatment may be a viable option for stable patients with resolving pancreatitis, although such cases are rare and require careful monitoring. Conclusion: While the primary approach to managing SAP remains interventional due to the high risk of rupture, this case highlights the potential for spontaneous regression in select circumstances. It underscores the need for personalized treatment plans.