Introduction: Splenic artery pseudoaneurysm is a rare but devastating cause of GI hemorrhage. We discuss a case of a 66-year-old male presenting with hematemesis and subsequently developed massive GI hemorrhage secondary to splenic artery pseudoaneurysm rupture.
Description: 66-year-old male with a history of diabetes, neuropathy, hypertension, hyperlipidemia presented to the emergency room after a syncopal episode, hematemesis, and abdominal pain. Laboratory evaluation showed a mild acute kidney injury, leukocytosis, hemoglobin 10.9. CT abdomen without contrast showed intraluminal debris in the stomach with areas of mural thickening, a focal area of mesenteric stranding adjacent to the posterior wall, and gastric body with an area of possible gas concerning for focal micro perforation. Surgery and GI were consulted. He was transferred to a larger hospital for a barium swallow study. Prior to transfer he was stable and asymptomatic. Upon arrival he developed seizure like activity and was unresponsive. FAST exam was negative. Shortly after intubation he lost pulses with ROSC achieved. He developed copious hematemesis and melena. Massive transfusion protocols were ordered, and emergent femoral trauma lines were placed. CTA did not demonstrate active extravasation. Emergent bedside endoscopy was limited secondary to copious blood and did not identify the bleeding lesion. Arteriogram and embolization identified a splenic artery bleed. At the time of procedure he had received a total of 6 massive transfusion protocols and remained on high doses of IV vasopressors. Unfortunately the patient developed significant volume overload and was unable to appropriately oxygenate or ventilate and again lost pulses.
Discussion: Splenic artery pseudoaneurysm is a rare cause of hemorrhagic shock and GI bleed and are often secondary to trauma or pancreatitis and rarely from peptic ulcer disease. Due to high risk of hemorrhage and subsequent death, if identified, repair may be preferred compared to conservative management. EGD may fail to correctly diagnose splenic artery pseudoaneurysms. CT angiography can often diagnose splenic artery pseudoaneurysms, however negative result should not exclude this diagnosis. Treatment can be attempted endovascularly; however surgical ligation or even splenectomy are often required.
.jpg "Juhie Patel (she/her/hers) photo")
