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

Sawicki M, Marlicz W, Czapla N, Łokaj M, Skoczylas MM, Donotek M, Kołaczyk K - Pol J Radiol (2015)

Bottom Line: After negative results of endoscopy and ultrasound, the diagnosis was established in CT angiography.The successful treatment consisted of surgical ligation of the bleeding vessel and suture of the ulcer with preservation of the spleen and pancreas, which is rarely tried in such situations.In such cases, immediate CT angiography is useful in establishing diagnosis and in application of proper therapy before possible recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland.

ABSTRACT

Background: Splenic artery aneurysm and pseudoaneurysm are rare pathologies. True aneurysms are usually asymptomatic. Aneurysm rupture occurring in 2-3% of cases results in bleeding into the lesser sack, peritoneal space or adjacent organs typically presenting as abdominal pain and hemodynamic instability. In contrast, pseudoaneurysms are nearly always symptomatic carrying a high risk of rupture of 37-47% and mortality rate of 90% if untreated. Therefore, prompt diagnosis and treatment are essential in the management of patients with splenic artery pseudoaneurysm. Typical causes include pancreatitis and trauma. Rarely, the rupture of a pseudoaneurysm presents as upper gastrointestinal (UGI) bleeding. Among causes, peptic ulcer is the casuistic one.

Case report: This report describes a very rare case of recurrent UGI bleeding from a splenic artery pseudoaneurysm caused by a penetrating gastric ulcer. After negative results of endoscopy and ultrasound, the diagnosis was established in CT angiography. The successful treatment consisted of surgical ligation of the bleeding vessel and suture of the ulcer with preservation of the spleen and pancreas, which is rarely tried in such situations.

Conclusions: The most important factor in identifying a ruptured splenic artery pseudoaneurysm as a source of GI bleeding is considering the diagnosis. UGI hemorrhage from splenic artery pseudoaneurysm can have a relapsing course providing false negative results of endoscopy and ultrasound if performed between episodes of active bleeding. In such cases, immediate CT angiography is useful in establishing diagnosis and in application of proper therapy before possible recurrence.

No MeSH data available.


Related in: MedlinePlus

Follow-up CT in a 5-mm axial MPR shows epigastric pathological fluid collection (arrow) adjacent to the ligated vessel. The lesion was diagnosed as postoperative hematoma.
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f2-poljradiol-80-384: Follow-up CT in a 5-mm axial MPR shows epigastric pathological fluid collection (arrow) adjacent to the ligated vessel. The lesion was diagnosed as postoperative hematoma.

Mentions: A follow-up ultrasound performed next week revealed a perigastric fluid collection 5.0×3.5 cm in size adjacent to the bleeding site. A follow-up CT performed two weeks after surgery showed regression of the pathological fluid collection to 2.8 cm in diameter (see Figure 2). The lesion was interpreted as a resolving hematoma being a typical complication of surgery. The ligated branch of the splenic artery with pseudoaneurysm was excluded from circulation. No signs of bleeding were observed. Interestingly, no splenic infarct was detected.


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

Sawicki M, Marlicz W, Czapla N, Łokaj M, Skoczylas MM, Donotek M, Kołaczyk K - Pol J Radiol (2015)

Follow-up CT in a 5-mm axial MPR shows epigastric pathological fluid collection (arrow) adjacent to the ligated vessel. The lesion was diagnosed as postoperative hematoma.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4538884&req=5

f2-poljradiol-80-384: Follow-up CT in a 5-mm axial MPR shows epigastric pathological fluid collection (arrow) adjacent to the ligated vessel. The lesion was diagnosed as postoperative hematoma.
Mentions: A follow-up ultrasound performed next week revealed a perigastric fluid collection 5.0×3.5 cm in size adjacent to the bleeding site. A follow-up CT performed two weeks after surgery showed regression of the pathological fluid collection to 2.8 cm in diameter (see Figure 2). The lesion was interpreted as a resolving hematoma being a typical complication of surgery. The ligated branch of the splenic artery with pseudoaneurysm was excluded from circulation. No signs of bleeding were observed. Interestingly, no splenic infarct was detected.

Bottom Line: After negative results of endoscopy and ultrasound, the diagnosis was established in CT angiography.The successful treatment consisted of surgical ligation of the bleeding vessel and suture of the ulcer with preservation of the spleen and pancreas, which is rarely tried in such situations.In such cases, immediate CT angiography is useful in establishing diagnosis and in application of proper therapy before possible recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland.

ABSTRACT

Background: Splenic artery aneurysm and pseudoaneurysm are rare pathologies. True aneurysms are usually asymptomatic. Aneurysm rupture occurring in 2-3% of cases results in bleeding into the lesser sack, peritoneal space or adjacent organs typically presenting as abdominal pain and hemodynamic instability. In contrast, pseudoaneurysms are nearly always symptomatic carrying a high risk of rupture of 37-47% and mortality rate of 90% if untreated. Therefore, prompt diagnosis and treatment are essential in the management of patients with splenic artery pseudoaneurysm. Typical causes include pancreatitis and trauma. Rarely, the rupture of a pseudoaneurysm presents as upper gastrointestinal (UGI) bleeding. Among causes, peptic ulcer is the casuistic one.

Case report: This report describes a very rare case of recurrent UGI bleeding from a splenic artery pseudoaneurysm caused by a penetrating gastric ulcer. After negative results of endoscopy and ultrasound, the diagnosis was established in CT angiography. The successful treatment consisted of surgical ligation of the bleeding vessel and suture of the ulcer with preservation of the spleen and pancreas, which is rarely tried in such situations.

Conclusions: The most important factor in identifying a ruptured splenic artery pseudoaneurysm as a source of GI bleeding is considering the diagnosis. UGI hemorrhage from splenic artery pseudoaneurysm can have a relapsing course providing false negative results of endoscopy and ultrasound if performed between episodes of active bleeding. In such cases, immediate CT angiography is useful in establishing diagnosis and in application of proper therapy before possible recurrence.

No MeSH data available.


Related in: MedlinePlus