Panzera F, Inchingolo R, Rizzi M, Biscaglia A, Schievenin MG, Tallarico E, Pacifico G, Di Venere B. Giant splenic artery aneurysm presenting with massive upper gastrointestinal bleeding: A case report and review of literature. World J Gastroenterol 2020; 26(22): 3110-3117 [PMID: 32587452 DOI: 10.3748/wjg.v26.i22.3110]
Corresponding Author of This Article
Riccardo Inchingolo, MD, Doctor, Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Via Montescaglioso, Matera 75100, Italy. riccardoin@hotmail.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jun 14, 2020; 26(22): 3110-3117 Published online Jun 14, 2020. doi: 10.3748/wjg.v26.i22.3110
Giant splenic artery aneurysm presenting with massive upper gastrointestinal bleeding: A case report and review of literature
Francesco Panzera, Riccardo Inchingolo, Marina Rizzi, Assunta Biscaglia, Maria Grazia Schievenin, Emilia Tallarico, Giancarlo Pacifico, Beatrice Di Venere
Francesco Panzera, Marina Rizzi, Division of Gastroenterology, Department of Surgery, Madonna delle Grazie Hospital, Matera 75100, Italy
Riccardo Inchingolo, Assunta Biscaglia, Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Matera 75100, Italy
Maria Grazia Schievenin, Department of Intensive Care, Madonna delle Grazie Hospital, Matera 75100, Italy
Emilia Tallarico, Department of Pathology, Madonna delle Grazie Hospital, Matera 75100, Italy
Giancarlo Pacifico, Beatrice Di Venere, Division of General Surgery, Department of Surgery, Madonna delle Grazie Hospital, Matera 75100, Italy
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Informed consent statement: Informed consent has been obtained from the patient.
Conflict-of-interest statement: All the authors are aware of the content of the manuscript and have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Riccardo Inchingolo, MD, Doctor, Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Via Montescaglioso, Matera 75100, Italy. riccardoin@hotmail.it
Received: March 15, 2020 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
Abstract
BACKGROUND
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.
CASE SUMMARY
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.
CONCLUSION
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.
