Pancreatitis induced ruptured pseudoaneurysm (PSA) of the peri-pancreatic and splenic arteries may become a source of life-threatening hemorrhage. Its management is challenging and requires an individualized and multidisciplinary approach. The index case is a 32-year-old chronic alcoholic male presented with multiple episodes of hematemesis and melena. Pathological and imaging findings were consistent with anemia and acute pancreatitis with ruptured PSA of branch of splenic artery, portal cavernoma formation, and splenomegaly. Thrombosis of PSA sac, embolization of offending branch of splenic artery, and splenic infarction were successfully contemplated in a single session by direct percutaneous embolization with gelfoam and glue as embolic agents under guidance of duplex ultrasound imaging. We describe a modified sandwich embolization technique, its long-term success and complications of simultaneous management of ruptured PSA of branch of splenic artery and hypersplenism syndrome in limited resource scenario.

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Coronavirus disease‐19 (COVID‐19) infection causing severe gastrointestinal complications is rare. A 9‐year‐old child after recovering from mild COVID‐19 infection developed small bowel gangrene due to superior mesenteric artery thrombosis. He required resection of entire necrotic small bowel along with caecum causing ultra‐short bowel syndrome. Reverse transcriptase‐polymerase chain reaction (RT‐PCR) done on the resected specimen was positive for COVID‐19. He was maintained on individualized parenteral nutrition for 3 months. A living donor intestinal transplant was performed using 200 cm of ileum donated by the patient's father. The graft function was satisfactory and was not complicated with thrombosis, infection, reactivation of latent COVID‐19 or rejection. He could be weaned off completely from parenteral nutrition by postoperative day 21. The donor had an uneventful recovery. Six month follow‐up was satisfactory with the child achieving complete enteral autonomy as well as target goal nutrition. Thrombotic phenomena associated with COVID‐19 infection can affect larger vessel‐like superior mesenteric artery leading to small bowel gangrene. Intestine transplant could be done safely after 3 months of recovery from COVID‐19 without any adverse outcomes. Further studies are required to establish optimal timing and safety of small bowel transplant in this situation.

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Bleeding following restorative proctocolectomy for chronic ulcerative colitis is an uncommon complication. Usually bleeding occurs from the ileal pouch-anal anastomotic site in the early postoperative period. Significant pouch bleeding in the late postoperative course is rarely encountered. A mesenteric artery pseudoaneurysm along the ileal pouch staple line may be a cause of late-presenting massive per-rectal bleed. Although a rare phenomenon, it must be considered to be a differential in such a situation.