Splenic artery pseudoaneurysm presenting with massive rectal bleeding

Abdul, Rishard; Teelucksingh, Sachin; Omar, M D M D Firas Hussein and Zainab; Chow, Andrew Chan; Boppana, Leela Krishna Teja; Goli, Sanjeeva; Naraynsingh, Vijay; Teelucksingh, Surujpal

doi:10.1016/j.radcr.2019.03.038

Cited by 5 publications

(4 citation statements)

References 9 publications

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“…Pseudoaneurysms form because of injury to the vessel wall allowing blood to flow extraluminally which is contained by surrounding tissue [ 15 ]. Injury resulting in splenic artery pseudoaneurysm (SAP) formation are most commonly associated with acute and chronic pancreatitis, as well as abdominal trauma, gastric ulceration, pancreatic and gastric cancers, and infection [ 1 – 5 , 8 , 16 – 18 ]. When secondary to infection, they are termed mycotic pseudoaneurysms.…”

Section: Discussionmentioning

confidence: 99%

“…Splenic artery pseudoaneurysms (SAPs) are rare and occur mainly secondary to pancreatitis, abdominal trauma, gastric ulcers, pancreatic and gastric cancers, and infections (especially in IV drug users) [ 1 – 8 ].They are best diagnosed using computed tomography angiography (CTA) [ 3 , 4 , 9 – 11 ] and best treated using endovascular embolization [ 4 , 9 , 10 ] but, in some cases open or laparoscopic surgical intervention is necessary [ 4 , 9 , 12 ]. Ruptured SAPs are an important differential diagnosis to consider when a patient presents with abdominal pain, hemoperitoneum, hematemesis, or hematochezia in the setting of the previously mentioned risk factors due to its high risk of mortality (> 90%) if left untreated [ 3 – 6 , 8 , 9 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous rupture of a mycotic splenic artery pseudoaneurysm secondary to histoplasmosis: a case report

Mirande,

Souza,

Thibodeaux

et al. 2024

surg case rep

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Background A splenic artery pseudoaneurysm is a rare pathology that occurs mainly secondary to pancreatitis, abdominal trauma, peptic ulcers, pancreatic and gastric cancers, and infections. It is best diagnosed using computed tomography angiography and typically treated using endovascular embolization and, in some cases, open or laparoscopic surgery. In this report, we present a case of a ruptured mycotic splenic artery pseudoaneurysm containing Histoplasma capsulatum, which to our knowledge is the first case to report a mycotic splenic artery pseudoaneurysm of this nature. Case presentation We report a case of a 42-year-old white male with past medical history of Hepatitis C and IV drug abuse who presented to the Emergency Department with a 24-h history of severe diffuse abdominal pain. He was tachycardic and peritonitic on exam. Work-up demonstrated leukocytosis and lactic acidosis. Computed tomography of the abdomen and pelvis with intravenous contrast showed hemoperitoneum and active extravasation of contrast from the splenic artery into the splenic hilum, associated with a surrounding hematoma measuring 5.3 × 5.0 cm, concerning for ruptured splenic artery pseudoaneurysm. The patient was taken emergently for exploratory laparotomy, where a large intraperitoneal hematoma was evacuated. A ruptured splenic artery pseudoaneurysm was identified, isolated, and controlled, followed by completion splenectomy. Final pathology demonstrated a 3.0 × 1.3 × 0.3 cm pseudoaneurysm wall and a 14 × 9.5 × 5.5 cm spleen containing multiple necrotizing granulomata positive for the presence of Histoplasmosis species. The patient recovered appropriately and was discharged on post-operative day five. Conclusions This case demonstrates a successful approach to a ruptured mycotic splenic artery pseudoaneurysm resulting in a positive outcome. It is a unique case as it highlights, to our knowledge, the first report of splenic artery aneurysm secondary to Histoplasma capsulatum infection. This report helps further the understanding of the pathophysiology as well as the natural history of mycotic splenic pseudoaneurysms.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Spontaneous rupture of a mycotic splenic artery pseudoaneurysm secondary to histoplasmosis: a case report

Mirande,

Souza,

Thibodeaux

et al. 2024

surg case rep

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“…Acute GI hemorrhage evidenced by physical examination findings of melena and hematochezia is often attributed to bleeding into the pancreatic duct, a phenomenon known as hemosuccus pancreaticus [ 9 ]. However, cases have also been reported of acute pseudoaneurysm bleeding into the stomach, colon, and the peritoneal cavity directly [ 9 , 10 ]. Given their rarity with less than 250 reported cases, the timely detection of ruptured SAPs in the setting of an acute UGIB requires a very high level of suspicion.…”

Section: Discussionmentioning

confidence: 99%

Acute Gastric Hemorrhage due to Gastric Cancer Eroding Into a Splenic Artery Pseudoaneurysm: Two Dangerously Rare Etiologies of Upper Gastrointestinal Bleeding

Cartelle

Yap

2020

Cureus

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Splenic artery pseudoaneurysms (SAPs) are rare causes of upper gastrointestinal bleeding (UGIB), with less than 250 reported cases in the literature. The highest incidence of SAPs is in patients with a history of acute or chronic pancreatitis or splenic artery trauma. SAP in the setting of gastric malignancy is an exceedingly rare finding. We present the unusual hospital course of an 82-year-old male with advanced gastric cancer presenting with UGIB secondary to a visceral communication between his known gastric malignancy and a SAP.

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“…Splenic artery pseudoaneurysm (SAP) is a rare phenomenon with an estimated prevalence amongst the general population of <1%. However, some sub-groups of patients are at much higher risk, particularly those with a history of chronic pancreatitis, pancreatic pseudocyst and previous abdominal trauma [ 1 ]. The choice of treatment for ruptured SAP has varied in the literature.…”

Section: Introductionmentioning

confidence: 99%

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

Holt

Schwalb

2020

Journal of Surgical Case Reports

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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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Splenic artery pseudoaneurysm presenting with massive rectal bleeding

Cited by 5 publications

References 9 publications

Spontaneous rupture of a mycotic splenic artery pseudoaneurysm secondary to histoplasmosis: a case report

Spontaneous rupture of a mycotic splenic artery pseudoaneurysm secondary to histoplasmosis: a case report

Acute Gastric Hemorrhage due to Gastric Cancer Eroding Into a Splenic Artery Pseudoaneurysm: Two Dangerously Rare Etiologies of Upper Gastrointestinal Bleeding

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

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