A rare case of massive lower gastrointestinal bleeding from a ruptured splenic artery aneurysm

Abstract

Splenic artery aneurysms (SAAs) are an extremely rare cause of asymptomatic massive lower gastrointestinal bleeding with less than a handful of patients surviving such a presentation. A 24-year-old female presented in shock after multiple episodes of massive rectal bleeding. Imaging revealed a heterogeneous mass arising from the tail of the pancreas eroding into the splenic flexure of the colon. Further episodes of bleeding led to an exploratory laparotomy. Intraoperatively, a suspected neoplastic process arising from the tail of the pancreas with contiguous involvement of the splenic flexure of the colon and the greater curvature of the stomach was noted. Distal pancreaticosplenectomy, gastric wedge resection with segmental colectomy and primary anastomosis were performed. Histology revealed a SAA with rupture into the colon. This case report shows that en-bloc resection of a ruptured SAA can be performed with success in the emergency setting.

Splenic artery pseudoaneurysm presenting with massive rectal bleeding

“…Resection of adjacent structures is done based on invasion. Of note, in our case we were able to preserve the stomach in comparison to the case described by Maharaj et al [1]. This was possible because of CT diagnosis of SAA and intraoperative confirmation of the same where there was no invasion into the stomach and no need to remove the sac since it was not a tumor.…”

“…There are reported cases of erosion and rupture into adjacent organs such as the stomach (presenting with symptoms of an upper gastrointestinal bleed), the duodenum (melena and hematemesis), as well as erosion into the splenic vein (resulting in an arteriovenous fistula with mesenteric steal and ischemic small bowel) [7]. As with the case outlined above, there have been cases where an SAA has eroded into the colon and resulted in hematochezia with hypovolemic shock [1], [8]; less than 200 such cases are described in the literature [9].…”

“…Albeit rare, rupture of a splenic artery aneurysm (SAA) is an important cause of gastrointestinal bleeding due to its high mortality and uncommon occurrence. [1] Following the aorta and the common iliac arteries, aneurysms of the splenic artery are reported as the third most common intraabdominal aneurysm and the most common visceral arterial aneurysm [2]. Many authors agree that its prevalence is estimated at less than 1% in the general population, 7%-20% in patients with liver cirrhosis and portal hypertension, and 8%-13% in patients following liver transplantation [3], [4].…”

Splenic Artery Aneurysm Case Report

“…In the common case, the rupture of spleen arrhythmia is more likely to happen when it is bigger than 2 centimeters or in a person who is pregnant, and care should be taken to treat these individuals (11). At present, the favored technique of treatment is embolization; moreover, embolization might fail in cases presenting tortuous splenic arteries, and there is no little follow-up information for this method, and recurrence is a possible long-term hazard.…”

Treatment experience of delayed massive gastrointestinal bleeding caused by intra-abdominal arteriointestinal fistula in gastric cancer patients after radical gastrectomy

“…Arteriointestinal fistula can also occur rarely in patients with no history of surgery. A previous study reported a case without previous operation in which a splenic artery aneurysm ruptured into the splenic flexure of the colon, leading to massive lower gastrointestinal bleeding [13]. The clinical manifestations of arteriointestinal fistula are diverse and non-specific.…”