A benign gastric ulcer eroding into a splenic artery pseudoaneurysm presenting as a massive upper gastrointestinal bleed

Abstract

Upper gastrointestinal (UGI) bleeding secondary to a ruptured splenic artery (SA) pseudoaneurysm into the stomach is a rare but a life-threatening condition. Owing to the low prevalence, it remains a diagnostic and therapeutic challenge. A frail 77-year-old Caucasian female presented with epigastric pain and hematemesis. Endoscopy was non-diagnostic for an etiology. She then underwent diagnostic angiography that revealed an SA pseudoaneurysm with active contrast extravasation into the stomach. Subsequent transcatheter arterial coil embolization was conducted of the SA. The patient was subsequently taken for a partial gastrectomy, distal pancreatectomy and splenectomy. She had an uncomplicated postoperative course.Diagnosis of an UGI bleeding secondary to a ruptured SA pseudoaneurysm into the stomach remains difficult. However, we report that in a hemodynamically stable patient, a multidisciplinary approach can be taken, with interval optimization of the patient prior to definitive surgery for a satisfactory outcome.

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

“…The causes of SA pseudoaneurysm include pancreatitis (52%), trauma (29%) and postoperative causes (3%), and, rarely, peptic ulcer disease (2%). [ 2 ] The most common presentations of SA pseudoaneurysm are hematochezia or melena (26.2%), hemorrhage into the pancreatic duct (hemosuccus pancreaticus) (20.3%), and hematemesis (14.8%). [ 4 ]…”

“…In this case, SA pseudoaneurysm induced by gastric ulcer perforation required additional surgery to remove the bleeding cause as shown in the previous reports. [ 2 , 8 ] In addition, the endovascular therapy played an effective role to facilitate preoperative hemodynamic stabilization and to secure the visual field during operation.…”

Massive Upper Gastrointestinal Bleeding from a Splenic Artery Pseudoaneurysm Caused by a Penetrating Gastric Ulcer: Case Report and Review of Literature

“…To our best knowledge, only four cases of the same etiology have been reported in the literature [4,6]. However, the presented case is unique due to the unusual clinical course resembling “double rupture” behavior, which made it diagnostically challenging.…”

A case of splenic artery pseudoaneurysm rupture in a bulimic patient with gastric ulcer

“…3 Splenic artery pseudo aneurysm is a rare entity caused mostly by pancreatitis (acute and chronic) and trauma (including iatrogenic causes), while the association with peptic disease is uniquely cited in a few case reports, only three up to 2003 as reported by Tessier et al 4 and other four up to 2018. [5][6][7][8] Just like in pancreatitis, the arterial walls weakening is attributed to digestion of the splenic artery by pancreatic enzymes, probably gastric acid plays the same role on the vessel layers, leading to pseudo aneurysm formation. Presentation of splenic artery pseudo aneurysm varies from incidental finding to acute hemodynamic shock and, considering the rarity of this condition, diagnosis can be challenging.…”