Splenic Artery Pseudoaneurysm Presenting as Massive Hematemesis: A Diagnostic Dilemma

Abstract

Introduction. Splenic artery Pseudoaneurysm, a complication of chronic pancreatitis, presenting as massive hematemesis is a rare presentation. Case Report. We present a case of 38-year-old male admitted with chief complaints of pain in the upper abdomen and massive hematemesis for the last 15 days. On examination there was severe pallor. On investigating the patient, Hb was 4.0 gm/dL, upper GI endoscopy revealed a leiomyoma in fundus of stomach, and EUS Doppler also supported the UGI findings. On further investigation of the patient, CECT of the abdomen revealed a possibility of distal pancreatic carcinoma encasing splenic vessels and infiltrating the adjacent structure. FNA taken at the time of EUS was consistent with inflammatory pathology. Triple phase CT of the abdomen revealed a splenic artery pseudoaneurysm with multiple splenic infarcts. After resuscitation we planned an emergency laparotomy; splenic artery pseudoaneurysm densely adherent to adjacent structures and associated with distal pancreatic necrosis was found. We performed splenectomy with repair of the defect in the stomach wall and necrosectomy. Postoperative course was uneventful and patient was discharged on day 8. Conclusion. Pseudoaneurysm can be at times a very difficult situation to manage; options available are either catheter embolisation if patient is vitally stable, or otherwise, exploration.

Splenic Artery Pseudoaneurysm Masquerading as a Pancreatic Cyst—A Diagnostic Challenge

“…1 Our patient is, to the best of our knowledge, the youngest patient reported in the literature with this condition and with no apparent risk factors. This case study also reinforced a frequently encountered diagnostic dilemma, 4 with the underlying lesion masquerading as a possible gastrointestinal stromal tumor lesion on CT scan and cystic lesion of the pancreas on MRCP scan.…”

“…CT scan is often used in the acute clinical setting to exclude other life-threatening conditions and can usually diagnose SAP, but small pseudoaneurysms may be missed. 6 The gold standard for diagnosis is via direct catheter visceral angiography, 4 which has the dual advantage of being both diagnostic and therapeutic. However, our patient did not have this window of opportunity, because he was hemodynamically unstable.…”

Splenic artery pseudoaneurysm with splenic infarction induced by a benign gastric ulcer

“…Current therapeutic options of SA pseudoaneurysm have been reported as embolization (37%), splenectomy and distal pancreatectomy ((26%), splenectomy alone (11%), ligation alone (10%), endovascular stenting (4%), ligation and splenectomy (3%), distal pancreatectomy alone (3%), and gastrectomy and splenectomy (1%). [ 1 , 8 ] Endovascular approaches to manage the SA aneurysm offer an alternative to conventional surgery and are associated with high success rate and low procedure-related morbidity and mortality. [ 9 ] Conservative treatment leads to patient stabilization if the SA pseudoaneurysm is caused by pancreatitis or postoperative causes, successfully treated with endovascular therapy.…”

Case report and systematic literature review of a novel etiology of sinistral portal hypertension presenting with UGI bleeding

“…Pancreatitis is the most common cause of PAs of this branch or other branches of the celiac axis. [40,51,52] Pancreatitis causes leakage of pancreatic enzymes that injure the intima and media, the 2 innermost vascular layers, which then merge with pancreatic pseudocysts to create a false cavity communicating with the arterial lumen. [43,53] …”