Hemorrhagic Shock Revealing Rupture of Splenic Artery Pseudoaneurysm Three Years After Post-Traumatic Pancreatitis

Abstract

Splenic artery pseudoaneurysm (SAP) is an uncommon entity but extremely serious, given the high mortality rate if untreated. Only a limited literature reports association with post-traumatic pancreatitis. We report the case of a 30-year-old man, who was brought to the emergency department (ED) for acute confusion. His past medical history includes trauma of right hypochondriac and epigastric regions, three years ago. Three days before his admission to the hospital, he experienced abdominal pain with nausea and vomiting, without transit disorders or fever. When examined, the patient was disoriented, pale with profuse sweating, cold extremities, and a temperature of 36.3°C. Blood pressure was 75/51 mmHg, heart rate was 126 beats per minute, and oxygen saturation was 96% on room air. The abdominal exam detected generalized abdominal sensitivity. A CT angiography of the abdomen revealed hemoperitoneum of medium abundance, with extravasation of the contrast product from the splenic artery. The size of the spleen was normal with a lower polar hypodense area. In addition, a pancreas of normal size, steady outlinings, seat of bilobed cystic formation suggested a pancreatic pseudocyst. This led us to suspect a rupture of a pseudoaneurysm of the splenic artery. A laparotomy was performed and showed an estimated 2 L hemoperitoneum. Active bleeding was noted from an SAP in the mid-portion of the splenic artery, next to the pancreatic pseudocyst. Ligation of the splenic artery and splenectomy was carried out. The patient was discharged home on the 10th post-operative day. Our case highlights an uncommon cause of hemorrhagic shock, but critical to recognize. Indeed, ruptured SAP needs to be promptly detected and managed, to avoid fatal complications if left untreated.