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Solid pseudopapillary neoplasm is a rare epithelial tumor of the pancreas with low malignant potential and a marked predilection for adolescent girls and young women. Although the overall prognosis is favorable after complete resection, preoperative characterization and surgical planning become more challenging in giant tumors with intratumoral degeneration, hemorrhage, and adjacent vascular compression. We report a 15-year-old girl who presented with acute abdominal pain persisting for 24 hours after strenuous physical activity. Imaging revealed a giant mixed solid-cystic mass in the pancreatic body and tail, and computed tomography angiography and venography demonstrated narrowing of the splenic vein with collateral venous circulation. After multidisciplinary assessment of oncologic safety and perioperative bleeding risk, the patient underwent laparoscopic distal pancreatectomy with splenectomy. Histopathology confirmed solid pseudopapillary neoplasm with negative margins and no nodal metastasis; ectopic splenic tissue was identified in the peripancreatic fat. Immunohistochemistry showed nuclear/cytoplasmic positivity for beta-catenin, loss of E-cadherin, positivity for CD10 and CD56, and partial positivity for lymphoid enhancer-binding factor 1, supporting the diagnosis. The postoperative course was uneventful, and no evidence of recurrence was detected on short-term follow-up. This case suggests that giant solid pseudopapillary neoplasm may have been related to acute abdominal pain in the setting of intratumoral degeneration, hemorrhagic change, and local tension effect. Surgical strategy should balance oncologic safety, bleeding risk, and organ preservation. In patients requiring splenectomy, long-term infection prevention should include immunization planning, fever emergency counseling, and individualized antibiotic prophylaxis according to local guidance and risk stratification.