Splenic artery pseudoaneurysm following chemotherapy in a patient with pancreatic cancer: a case report

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.