• Hiroyuki Ishida, Yoshiya Ishikawa, Keiichi Akahoshi, Hiroki Ueda, Koichiro Morimoto, Hironari Yamashita, Kosuke Ogawa, Hiroaki Ono, Atsushi Kudo, Shinji Tanaka, and Minoru Tanabe.
• Department of Hepatobiliary and Pancreatic Surgery.
• Medicine (Baltimore). 2021 May 7; 100 (18): e25704e25704.

RationaleSplenic artery originating from the superior mesenteric artery is extremely rare. Because of this, its significance in laparoscopic distal pancreatectomy has never been reported. Here, we present the first case of laparoscopic distal pancreatectomy in a patient with a splenic artery arising from the superior mesenteric artery.Patient ConcernsA 46-year-old Japanese woman with type 2 diabetes mellitus presented with worsening glycemic control. Abdominal ultrasonography revealed a pancreatic tail mass.DiagnosesThe patient was diagnosed with pancreatic neuroendocrine tumor by endoscopic ultrasound-guided fine needle aspiration. Preoperative computed tomography showed that the splenic artery with branches of dorsal pancreatic artery originated from the superior mesenteric artery.InterventionsThe patient underwent laparoscopic distal pancreatectomy. Prior to pancreatectomy, the splenic artery and its dorsal pancreatic branches were clamped using the superior and inferior approaches, respectively, to avoid bleeding and congestion.OutcomesThe postoperative course was uneventful.LessonsPreoperative evaluation of anatomical variants and development of strategies are important to avoid intraoperative complications in pancreatic surgery. Our results revealed that laparoscopic distal pancreatectomy can be performed safely by strategic approach even in a patient with a rare aberrant splenic artery.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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