Published online Jun 14, 2020. doi: 10.3748/wjg.v26.i22.3110
Peer-review started: March 15, 2020
First decision: April 25, 2020
Revised: April 29, 2020
Accepted: May 29, 2020
Article in press: May 29, 2020
Published online: June 14, 2020
Processing time: 91 Days and 1.9 Hours
Splenic artery aneurysm (SAA) and pseudoaneurysm are rare vessel’s lesions. Pseudoaneurysm is often symptomatic and secondary to pancreatitis or trauma. True SAA is the most common aneurysm of visceral vessels. In contrast to pseudoaneurysm, SAA is usually asymptomatic until the rupture, with high mortality rate. The clinical onset of SSA’s rupture is a massive life-threatening bleeding with hemodynamic instability, usually into the free peritoneal space and more rarely into the gastrointestinal tract.
We describe the case of a 35-year-old male patient, with negative past medical history, who presented to the emergency department for massive upper gastrointestinal bleeding, severe anemia and hypotension. An esophagogastroduodenoscopy performed in emergency showed a gastric bulging in the greater curvature/posterior wall with a small erosion on its surface, with a visible vessel, but no active bleeding. Endoscopic injection therapy with cyanoacrylate glue was performed. Urgent contrast-enhanced computed tomography was carried out due to the clinical scenario and the unclear endoscopic aspect: The radiological examination showed a giant SAA which was adherent to posterior stomach wall, and some smaller aneurysms of the left gastric and ileocolic artery. Because of the high risk of a two-stage rupture of the giant SAA with dramatic outcome, the patient underwent immediate open surgery with aneurysmectomy, splenectomy and distal pancreatectomy with a good postoperative outcome.
The management of a ruptured giant SAA into the stomach can be successful with surgical approach.
Core tip: Splenic artery aneurysm (SAA) is a rare vessel’s lesion, despite is the most common aneurysm of visceral vessels. We present herein, a rare case of spontaneous rupture of a giant SAA into the stomach, in a previously healthy male patient. This case highlights the importance of the contrast enhanced computed tomography in case of unclear endoscopic aspect and the urgent surgical treatment in order to prevent a two-stage rupture.