Abstract
BackgroundEpigastric pain is frequent in Emergency Medicine and remains a challenging situation. Besides benign etiologies such as gastritis or uncomplicated cholelithiasis, it could reveal myocardial infarction or vascular disease. Point-of-care ultrasound (POCUS) could be performed in such situation.Case presentationA healthy 66-year-old man with no previous medical history was admitted to the Emergency Department for a rapid onset epigastric pain. He reported taking non-steroidal anti-inflammatories for 1 week prior to admission. His pain had rapidly subsided and the physical examination was inconclusive. ECG and blood samples were normal. POCUS revealed a vascular mass located between the spleen and the left kidney measuring 80 * 74 mm associated with small amounts of free peritoneal fluid. Computed tomography diagnosed a fissurated giant aneurysm of the splenic artery. The aneurysm was managed emergently by endovascular exclusion by selective splenic artery embolization. The post-intervention course was uneventful and the patient was discharged home 3 days later. The patient has remained free from any complications of the embolization 6 months after the procedure.ConclusionSpontaneously regressive epigastric pain with a normal physical and biology/ECG should not necessarily reassure the physician, in particular if patients have cardiovascular risk factors. A POCUS should be considered for these patients.
Highlights
Epigastric pain is frequent in Emergency Medicine and remains a challenging situation
A Point-of-care ultrasound (POCUS) should be considered for these patients
Splenic artery aneurysms (SAA) were reported in 0.78% of 3600 non-selective angiograms [4]; the incidence increases with female gender, in older patients and portal hypertension [5]
Summary
Epigastric pain is a frequent and often challenging situation in the Emergency Department (ED) [1] Besides benign etiologies such as gastritis or uncomplicated cholelithiasis, it could reveal myocardial infarction, aortic, or vascular diseases. We report a case of a patient consulting in the ED for epigastric pain in whom point-of-care ultrasound (POCUS) revealed an acute fissuration of a giant splenic aneurysm. Case report A healthy 66-year-old man with no previous medical history was admitted to the ED for a first episode of rapid onset severe epigastric pain. It appeared at rest without associated symptoms such as dyspnea or vomiting. The patient has remained free from any complications of the embolization 6 months after the procedure
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