Published online Jul 25, 2016. doi: 10.4253/wjge.v8.i14.496
Peer-review started: March 21, 2016
First decision: May 17, 2016
Revised: May 23, 2016
Accepted: June 14, 2016
Article in press: June 16, 2016
Published online: July 25, 2016
Processing time: 125 Days and 11.2 Hours
We are reporting the rare case of splenic artery aneurysm of 4 cm of diameter presenting as a sub mucosal lesion on gastro-duodenal endoscopy. This aneurysm was treated by endovascular coil embolization and stent graft implantation. The procedure was uneventful. On day 1, the patient presented an acute severe epigastric pain and cardiovascular arrest. Abdominal computed tomography scan showed an active leak of the intravenous contrast dye in the peritoneum from the splenic aneurysm. We performed an emergent resection of the aneurysm, and peritoneal lavage. Postoperatively, hemorrhagic choc was refractory to large volumes replacement, and intravenous vaso-active drugs. On day 2, he presented massive hematochezia. We performed a total colectomy with splenectomy and cholecystectomy for ischemic colitis, with spleen and gallbladder infarction. Despite vaso-active drugs and aggressive treatment with Factor VIIa, the patient died after uncontrolled disseminated intravascular coagulation.
Core tip: Recently, a per-cutaneous endovascular embolization procedure has become the first-line treatment for splenic artery aneurysm. This rare presentation, in this case, as sub-mucosal gastric lesion and bleeding after embolization of the aneurysm showed the gravity of this entity when the diameter of aneurysm is > 2 cm. Although the risk of rupture is low, ruptured splenic artery aneurysm carry a high mortality rate.