LGAAs are a rare entity, with higher incidence in patients suffering from chronic pancreatitis and stomach cancer. Their clinical presentation is predominantly asymptomatic; however, they can lead to rupture and death. Diagnosis is often incidental, by CT angiography performed for other pathologies or in case of acute abdominal pain following rupture. A 60-year-old man was investigated for anemia. Workup revealed a previously unknown LGAA. He was then treated with embolization with a good postoperative outcome. According to the literature, the treatment is mainly endovascular, however many cases of open surgical treatment are described, especially when major bleeding complications occur, or when endovascular treatment results in incomplete exclusion of the aneurysmal sac. In patients with chronic pancreatitis or polyaneurysmal disease, LGAAs should be investigated. Endovascular treatment remains the first choice; however, it remains essential to be aware of the principles of open surgical treatment. 

Gianluca Massaini is graduated in Medicine and Surgery at the University of Florence (2017). He completed his formation in Vascular Surgery in the University Hospital of Florence (AOU Careggi) and in the New San Giovanni di Dio Hospital (Florence). He has 4 publications and a role as a Vascular Surgeon at Sant’Anna Hospital- ASST Lariana, Como (Italy).