Hematemesis in Alcoholics: Not Always the Same Problem. A Case Report of Successful Percutaneous Arterial Embolization of Spontaneously Ruptured Splenic Artery Aneurysm Causing Hematemesis, Hematochezia and Hemodynamic Instability

Abstract

The manuscript presents a rare case of overt upper gastrointestinal bleeding initially manifesting as coffee ground vomiting, in a patient who had negative esophagogastroduodenoscopy performed a few hours before. Over the first 30 minutes in the Emergency Department, the patient developed an episode of hematemesis and hematochezia with hemodynamic instability. To identify the source of bleeding, contrast-enhanced computed tomography was performed, which revealed a small aneurysm in the central part of the splenic artery with signs of intrapancreatic rupture. Re-esophagogastroduodenoscopy revealed active bleeding from the papilla of Vater and urgent selective angiography of the celiac trunk confirmed active extravasation of the contrast material into the main pancreatic duct. Successful embolization of the bleeding vessel was obtained by placing two coils in the aneurysm sac and the splenic artery. The presented clinical case draws attention to a rare case of spontaneously ruptured splenic artery aneurysm causing visible only periodically hemosuccus pancreaticus, progressing quickly to a life-threatening condition and requiring firm and fast multi-profile treatment.