Haematochezia from a Splenic Artery Pseudoaneurysm Communicating with Transverse Colon: A Case Report and Literature Review.

James O’Brien,Aser Farghal,Francesca Muscara,Irshad Shaikh

doi:10.1155/2016/8461501

James O’Brien, Aser Farghal + Show 2 more

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https://doi.org/10.1155/2016/8461501

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Abstract

Splenic artery aneurysms (SAA) are the third most common intra-abdominal aneurysm. Complications include invasion into surrounding structures often in association with preexisting pancreatic disease. We describe an 88-year-old female, with no history of pancreatic disease, referred with lower gastrointestinal bleeding. CT angiography showed a splenic artery pseudoaneurysm with associated collection and fistula to the transverse colon at the level of the splenic flexure. The pseudoaneurysm was embolised endovascularly with metallic microcoils. Rectal bleeding ceased. The patient recovered well and follow-up angiography revealed no persistence of the splenic artery pseudoaneurysm. SAA rupture results in 29%–50% mortality. Experienced centres report success with the endovascular approach in haemodynamically unstable patients, as a bridge to surgery, and even on a background of pancreatic disease. This case highlights the importance of prompt CT angiography, if endoscopy fails to identify a cause of gastrointestinal bleeding. Endovascular embolisation provides a safe and effective alternative to surgery, where anatomical considerations and local expertise permit.

Highlights

Splenic artery aneurysms (SAA) are defined as a ≥1 cm dilatation of the artery diameter and are the third most common intra-abdominal aneurysm [1]
We describe successful endovascular management of a splenic artery pseudoaneurysm, with a fistula between the pseudoaneurysm and the transverse colon, in a patient without coexisting pancreatic disease
Splenic artery aneurysms and pseudoaneurysms are rarely encountered in routine practice but will increasingly be identified as incidental findings

Summary

Introduction

Splenic artery aneurysms (SAA) are defined as a ≥1 cm dilatation of the artery diameter and are the third most common intra-abdominal aneurysm [1]. The majority of SAA are detected as incidental findings, but if they present with rupture, a high mortality rate results [2]. Complications include invasion into and communication with surrounding structures, often in association with preexisting pancreatic disease [1, 3]. Treatment of SAA was through surgery, but endovascular therapy is established with minimal morbidity and mortality [4]. We describe successful endovascular management of a splenic artery pseudoaneurysm, with a fistula between the pseudoaneurysm and the transverse colon, in a patient without coexisting pancreatic disease

Case Report

Findings

Discussion

Conclusions