Gastric hemorrhage as a late complication of splenic artery aneurysm repair: A dramatic way to vent one's spleen

Worthley, Daniel L.; Rayner, Christopher K.; Devitt, Peter G.; Fraser, Robert D.

doi:10.1046/j.1440-1746.2003.03012.x

Cited by 3 publications

(4 citation statements)

References 6 publications

(6 reference statements)

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“…1 –5 There is one report of gastric hemorrhage as a late complication of splenic artery aneurysm repair in a 68-year-old patient that was due to gastric collateralls. 6 Therefore, we suggest that when splenic artery occlusion occurs early in life, more significant collaterals will develop from adjacent proximal patent arteries, such as the gastric arteries. Collateral supply may be clinically asymptomatic for a long time or may present with massive fatal hematemesis from erosion of submucosal arterial collaterals due to any cause.…”

Section: Discussionmentioning

confidence: 95%

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Transcatheter Embolization of Extensive Left Gastric Artery Collaterals Presenting With Massive Upper Gastrointestinal Bleed

Saddekni

Abdelaal

Oser

et al. 2012

Vasc Endovascular Surg

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We report a case of extensive left gastric artery collaterals that were formed in the region of gastric fundus due to splenic artery occlusion and resulted in massive hematemesis. These collaterals were thought to be portosystemic collaterals related to portal hypertension during upper endoscopy study and single-phase venous computed tomography studies. The collaterals were treated by transcatheter endovascular coil embolization. Our case highlights the importance of recognizing and differentiating left gastric artery collaterals from gastric venous varices as a cause of hematemesis since the treatment approach for each condition is totally different. It also introduces the feasibility of percutaneous left gastric artery embolization as a treatment for this condition, without the need for surgical splenectomy and partial gastrectomy which have a higher mortality and morbidity.

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Section: Discussionmentioning

confidence: 95%

“…Surgical treatment options for this condition includes clamping of the splenic hilum with partial gasterctomy 1 ; ligation of left gastric artery with splenectomy 2 ; ligation of splenic artery, splenic vein, left, and short gastric arteries with splenectomy 5 ; and partial gastric devascularization and splenectomy. 6…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Embolization of Extensive Left Gastric Artery Collaterals Presenting With Massive Upper Gastrointestinal Bleed

Saddekni

Abdelaal

Oser

et al. 2012

Vasc Endovascular Surg

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“…These submucosal collaterals may be misinterpreted as varices on upper endoscopy (Mnatzakanian et al, 2008 ) and endoscopic injection of sclerosant agents might be a suboptimal treatment with potential non-target migration of the injected material. Enlarged gastrosplenic collaterals have been described in patients with congenital absence of the splenic artery (Spriggs, 1984 ) and in patients with main splenic artery occlusion related to different etiologies, including blunt abdominal trauma (Baron et al, 2000 ), splenic artery surgery, including aneurysmectomy and main splenic artery ligation after liver transplantation (Worthley et al, 2003 ; Keramidas et al, 1984 ). Irrespective of the underlying etiology of absence or occlusion of the main splenic artery, gastrosplenic collaterals may develop in the gastric wall and erode in the gastric lumen, resulting in severe intestinal bleeding.…”

Section: Discussionmentioning

confidence: 99%

Upper gastrointestinal bleeding related to an eroded gastrosplenic collateral lately after splenic artery embolization

et al. 2022

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Background Upper gastrointestinal, non-variceal haemorrhage can be related to various etiologies, including peptic ulcer, neoplasm, gastritis, Dieulafoy lesions and other, rare underlying diseases. Here, we describe another, yet unreported etiology of gastric bleeding. Case presentation A 49-year-old man presented with melena; gastroscopy revealed blood in the stomach without active bleeding source. Computed tomography angiography demonstrated a cluster of enlarged gastrosplenic arterial collaterals in the gastric wall and coils in the splenic artery, related to an embolization procedure 30-years ago for splenic trauma. Definitive treatment included catheter-directed glue embolization of the left gastric artery and the enlarged gastrosplenic collaterals. The postinterventional course was uneventful and no recurrence of upper gastrointestinal bleeding was noted after 6 months of follow-up. Conclusions Upper gastrointestinal bleeding associated with eroded gastrosplenic collaterals, related to previous splenic artery embolization, can be successfully treated with glue-embolization.

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“…Subsequently, Worthley and colleagues described a case of UGIB secondary to SAO due to previous SA aneurysmectomy. As previously reported, it was managed by angiography followed by splenectomy with ligation of the splenic vein and artery together with the left gastric and short gastric arteries[ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Massive bleeding from gastric submucosal arterial collaterals secondary to splenic artery thrombosis: A case report

Martino¹,

Serafino²,

Zito³

et al. 2022

World J Gastroenterol

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BACKGROUND Gastric submucosal arterial collaterals (GSAC) secondary to splenic artery occlusion is an extraordinary rare and potentially life-threatening cause of acute upper gastrointestinal bleeding. Here, we report a case of massive bleeding from GSAC successfully treated by means of a multidisciplinary minimally invasive approach. CASE SUMMARY A 60-year-old non-cirrhotic gentleman with a history of arterial hypertension was admitted due to hematemesis. Emergent esophagogastroduodenoscopy revealed pulsating and tortuous varicose shaped submucosal vessels in the gastric fundus along with a small erosion overlying one of the vessels. In order to characterize the fundic lesion, pre-operative emergent computed tomography-angiography was performed showing splenic artery thrombosis (SAT) and tortuous arterial structures arising from the left gastric artery and the left gastroepiploic artery in the gastric fundus. GSAC was successfully treated by means of a minimally invasive step-up approach consisting in endoscopic clipping followed by transcatheter arterial embolization (TAE). CONCLUSION This was a previously unreported case of bleeding GSAC secondary to SAT successfully managed by means of a multidisciplinary minimally invasive approach consisting in endoscopic clipping for the luminal bleeding control followed by elective TAE for the definitive treatment.

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Gastric hemorrhage as a late complication of splenic artery aneurysm repair: A dramatic way to vent one's spleen

Cited by 3 publications

References 6 publications

Transcatheter Embolization of Extensive Left Gastric Artery Collaterals Presenting With Massive Upper Gastrointestinal Bleed

Transcatheter Embolization of Extensive Left Gastric Artery Collaterals Presenting With Massive Upper Gastrointestinal Bleed

Upper gastrointestinal bleeding related to an eroded gastrosplenic collateral lately after splenic artery embolization

Massive bleeding from gastric submucosal arterial collaterals secondary to splenic artery thrombosis: A case report

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