Abstract
Splenic artery aneurysms (SAAs) are common visceral artery aneurysms with low prevalence. They are typically asymptomatic and discovered on incidental grounds. Multiple SAA, particularly large or giant ones, are extremely rare and are highly dangerous due to their propensity to rupture, particularly in the context of portal hypertension and thrombosis. We report a challenging and unusual case of a 36-year-old female who presented with epigastric pain and was found to have splenomegaly with several large SAAs and chronic splenic and portal vein thrombosis. She was successfully treated with open splenectomy, splenic artery ligation, and distal pancreatectomy. This case highlights the difficulty in diagnosis, surgical complexity, and rarity of multiple SAAs under chronic thrombosis, as well as the necessity of early management to prevent mortal consequences.