Spontaneous rupture of splenic artery pseudoaneurysm into walled-off pancreatic necrosis – A rare cause of recurrent hematochezia

Abstract Splenic artery pseudoaneurysm is a rare phenomenon most associated with chronic pancreatitis or previous trauma. Complications can include erosion and rupture into local structures, a situation that carries a reported mortality of 10–40%. A 58-year-old male with chronic alcoholic pancreatitis and a known splenic artery pseudoaneurysm presented to the emergency department of a regional hospital with rectal bleeding and sepsis. Computed tomography revealed a peri-splenic mass communicating with the splenic flexure. The patient was taken for an emergency splenectomy and left hemicolectomy and was confirmed to have rupture of the splenic artery aneurysm into the large bowel. This case presented with comparable features reported in the literature and demonstrates that access to emergency specialist surgical services in a regional setting offers the capability to manage rare, life threatening surgical emergencies.

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Tuberculous pancreatitis complicated by ruptured splenic artery pseudoaneurysm

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2013.5212 ◽

2013 ◽

Vol 79 (3-4) ◽

Cited By ~ 5

Author(s):

M. Irfan ◽

F. Thiavalappil ◽

J. Nagaraj ◽

T.H. Brown ◽

D. Roberts ◽

...

Keyword(s):

Lymph Nodes ◽

Splenic Artery ◽

Artery Pseudoaneurysm ◽

Pancreatic Tuberculosis ◽

Pancreatic Lymph Nodes ◽

Splenic Artery Pseudoaneurysm ◽

Draining Lymph Nodes

Tuberculous pancreatitis complicated by ruptured splenic artery pseudoaneurysm. M. Irfan, F. Thiavalappil, J. Nagaraj, T.H. Brown, D. Roberts, L. Mcknight, N.K. Harrison. Tuberculosis involving the pancreas is rare. We report a patient with pancreatic tuberculosis complicated by haemorrhage from a splenic artery pseudoaneurysm. As far as we are aware, the development of a splenic artery pseudoaneurysm in association with a large caseating mass of tuberculous pancreatic lymph nodes has not been reported previously. We review the literature and discuss the varied presentations of tuberculosis involving the pancreas or the pancreatic bed and its draining lymph nodes.

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Splenic artery pseudoaneurysm and resultant haematosuccus pancreaticus

BMJ Case Reports ◽

10.1136/bcr-2020-239485 ◽

2021 ◽

Vol 14 (3) ◽

pp. e239485

Author(s):

Shwetambari Sonanis ◽

Benjamin Layton ◽

Oliver Nicholson ◽

DA Subar

Keyword(s):

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Splenic Artery ◽

Clinical Symptoms ◽

Cross Sectional ◽

Artery Pseudoaneurysm ◽

Risk Of Rupture ◽

Cross Sectional Imaging ◽

Sectional Imaging ◽

Splenic Artery Pseudoaneurysm

Splenic artery pseudoaneurysm (SAP) is a rare and dangerous diagnosis with a high risk of rupture and death. It is the most common cause of main pancreatic duct haematoma—haematosuccus pancreaticus (HP). Neither SAP nor HP have specific clinical features that allow diagnosis without cross-sectional imaging. Upper gastrointestinal haemorrhage and a history of pancreatitis should raise clinical suspicion but ultimately endoscopy and CT are required. We report a case of a 51-year-old man without clinical symptoms in whom cross-sectional imaging was undertaken for incidental severe acute anaemia. This demonstrated stigmata of chronic pancreatitis and the main pancreatic duct was distended with dense material in keeping with haematoma. The diagnosis of a SAP bleeding into the main pancreatic duct was made radiologically. A subsequent oesophago-gastro-duodenoscopy confirmed the diagnosis. The imaging appearances, pathophysiology and management are discussed.

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Late Migration of a Covered Stent into the Stomach after Repair of a Splenic Artery Pseudoaneurysm

Journal of Radiology Case Reports ◽

10.3941/jrcr.v10i2.2620 ◽

2016 ◽

Vol 10 (2) ◽

Cited By ~ 1

Author(s):

Alberto Rebonato ◽

Daniele Maiettini ◽

Luigina Graziosi ◽

Miltiadis Krokidis ◽

Michele Rossi

Keyword(s):

Splenic Artery ◽

Covered Stent ◽

Artery Pseudoaneurysm ◽

Splenic Artery Pseudoaneurysm

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Splenic Artery Embolization for Post-Traumatic Splenic Artery Pseudoaneurysm in Children

Journal of Trauma and Acute Care Surgery ◽

10.1097/01.ta.0000044633.53328.f0 ◽

2004 ◽

Vol 57 (2) ◽

pp. 404-407 ◽

Cited By ~ 35

Author(s):

Dani Yardeni ◽

Theodore Z. Polley ◽

Arnold G. Coran

Keyword(s):

Splenic Artery ◽

Artery Embolization ◽

Splenic Artery Embolization ◽

Artery Pseudoaneurysm ◽

Post Traumatic ◽

Splenic Artery Pseudoaneurysm

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Successful endovascular management of giant splenic artery aneurysms

Vascular ◽

10.1177/1708538113478744 ◽

2013 ◽

Vol 21 (5) ◽

pp. 317-322 ◽

Cited By ~ 4

Author(s):

M F Ho ◽

Y C Chan ◽

S W Cheng

Keyword(s):

Current Literature ◽

Splenic Artery ◽

Endovascular Management ◽

Main Trunk ◽

Artery Pseudoaneurysm ◽

Surgical Emergencies ◽

Co Morbidity ◽

Open Surgical Treatment ◽

Conventional Open Surgery ◽

Splenic Artery Pseudoaneurysm

Giant pseudoaneurysms of the splenic artery, with a diameter of 5 cm or more, are rare surgical emergencies, and conventional open surgery usually involves splenectomy. The aim of this study is to report two cases from our institution and to review the world's literature on successful endovascular treatment of patients with giant splenic artery pseudoaneurysms. A retrospective review of a prospectively entered departmental computerized database was performed for the two patients from our institution. Articles were searched electronically from PubMed and Medline, using the terms ‘giant splenic artery’, ‘endovascular’ and ‘embolization’; and relevant cases were reviewed from the world's literature. We hereby report two patients with giant splenic artery pseudoaneurysms who were treated successfully with endovascular procedures. In addition to the two patients from our institution, there were five patients with giant splenic artery pseudoaneurysms in the published literature who underwent successful endovascular management. The first patient of our series had the largest pseudoaneursym size of 7.2 × 8.1 cm, which is the largest documented pseudoaneursym in the current literature. We report two cases of giant splenic artery pseudoaneurysm with one being the largest pseudoaneurysm treated with endovascular technique in the current literature. Endovascular coil embolization of main trunk of splenic artery is less invasive than open surgical treatment for giant splenic artery pseudoaneurysm, and circumvents the problem of difficult exposure, especially in those patients with significant co-morbidity.

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A rare case report of acute upper gastrointestinal hemorrhage due to splenic artery pseudoaneurysm

SAGE Open Medical Case Reports ◽

10.1177/2050313x211061910 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110619

Author(s):

Nguyen Dinh Luan ◽

Nguyen Minh Duc ◽

Nguyen Hong Son ◽

Tran Minh Hien ◽

Le Anh Huy ◽

...

Keyword(s):

Gastrointestinal Hemorrhage ◽

Splenic Artery ◽

Artery Aneurysm ◽

Hemodynamic Instability ◽

Splenic Artery Aneurysm ◽

Upper Gastrointestinal Hemorrhage ◽

Artery Pseudoaneurysm ◽

Rare Case Report ◽

Upper Gastrointestinal ◽

Splenic Artery Pseudoaneurysm

Splenic artery aneurysm and splenic artery pseudoaneurysm are rare vascular pathologies. The splenic artery represents the third most common site for intra-abdominal aneurysms. In contrast with true splenic artery aneurysm, splenic artery pseudoaneurysm is typically symptomatic, presenting with a range of symptoms, from abdominal pain to hemodynamic instability due to rupture. However, gastrointestinal hemorrhage is an uncommon complication of splenic artery pseudoaneurysm. We report a case of acute upper gastrointestinal hemorrhage due to splenic artery pseudoaneurysm rupture. The patient was successfully treated by endovascular intervention.

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