Gastrointestinal Bleeding Secondary to Splenic Artery Pseudoaneurysm Fistulizing to the Colon

Abstract

Purpose: A rare case of GI bleeding from a post-splenectomy splenic artery pseudoaneurysm fistulizing to the colon is presented. Methods:Case Report: A 79 y/o male awoke with abdominal pain and rectal bleeding. Past history was notable for a splenectomy 6 yrs ago for immune thrombocytopenic purpura. He denied aspirin or NSAID use. Evaluation revealed a significant drop in hemoglobin (13 g/dL to 6.9 g/dL) and resuscitative measures were undertaken. Results: An emergent upper endoscopy was performed and was negative. At colonoscopy, a large 3–4 cm pulsatile lesion with ulceration and overlying adherent clot was seen in the proximal descending colon (Fig. 1). CT angiogram was performed which revealed a large hematoma in the splenic bed and visualization of the splenic artery coursing into this location with contrast extravasation. The patient declined surgery and subsequently underwent successful angiographic embolization of a large pseudoaneurysm at the distal splenic artery stump (Fig. 1). Repeat colonoscopy 6 weeks later revealed complete healing at the site of the eroding pseudoaneurysm.FigureConclusion: GI bleeding from splenic artery pseudoaneurysm (SAP) is an uncommon but potentially life-threatening condition. Risk factors for SAP include pancreatitis, posttraumatic, peptic ulcer disease, and iatrogenic. Lower GI bleeding due to erosion or fistulization of SAP to the colon is a very rare event that requires a high index of suspicion and appropriate endoscopic/imaging studies to arrive at a correct diagnosis. This case highlights the fact that SAP should be considered in the differential diagnosis of GI bleeding in individuals who have undergone splenectomy.