Haematochezia from a Splenic Artery Pseudoaneurysm Communicating with Transverse Colon: A Case Report and Literature Review

Abstract

Splenic artery aneurysms (SAA) are the third most common intra-abdominal aneurysm. Complications include invasion into surrounding structures often in association with preexisting pancreatic disease. We describe an 88-year-old female, with no history of pancreatic disease, referred with lower gastrointestinal bleeding. CT angiography showed a splenic artery pseudoaneurysm with associated collection and fistula to the transverse colon at the level of the splenic flexure. The pseudoaneurysm was embolised endovascularly with metallic microcoils. Rectal bleeding ceased. The patient recovered well and follow-up angiography revealed no persistence of the splenic artery pseudoaneurysm. SAA rupture results in 29%–50% mortality. Experienced centres report success with the endovascular approach in haemodynamically unstable patients, as a bridge to surgery, and even on a background of pancreatic disease. This case highlights the importance of prompt CT angiography, if endoscopy fails to identify a cause of gastrointestinal bleeding. Endovascular embolisation provides a safe and effective alternative to surgery, where anatomical considerations and local expertise permit.

Splenic artery pseudoaneurysm presenting with massive rectal bleeding

“…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].…”

A case of splenic artery pseudoaneurysm rupture presenting as rectal bleeding in a regional hospital

“…Splenic artery aneurysms (SAA) are a pathological widening of the splenic artery, subdivided into either a true aneurysm (72%) or a pseudoaneurysm (13%) [ 2 ]. SAP differs from a true aneurysm histologically in that a collection of blood forms between the tunica media and tunica adventitia rather than a circumferential dilation of the entire vessel wall.…”

Tratamento endovascular da hemorragia digestiva aguda por volumoso pseudoaneurisma esplênico: relato de caso e revisão da literatura

“…Since the most prevalent clinical presentation of this pathology is gastrointestinal bleeding, the first examinations ordered are generally diagnostic endoscopy and colonoscopy. Splenic artery pseudoaneurysms may rupture into the interior of a pseudocyst, into the peritoneal cavity, or into the retroperitoneal space, without digestive hemorrhage, or may form a fistula into the intestinal lumen, 20 the bile duct (hemobilia), or the interior of the pancreatic duct, 13,18 a condition known as hemosuccus pancreaticus. 16,[21][22][23] In the case described here, a UDE was conducted to investigate hematemesis, bleeding directly into the gastrointestinal tract.…”