Ballinas-Oseguera GA, Martínez-Ordaz JL, Sinco-Nájera TG, Caballero-Luengas C, Arellano-Sotelo J, Blanco-Benavides R

Language: Spanish
References: 21
Page: 268-273
PDF size: 315.72 Kb.

ABSTRACT

Background: Splenic pseudoaneurysm is an uncommon disease. It occurs as a consequence of injury to the vascular wall, mostly inflammatory. The main symptom is gastrointestinal bleeding. The objective of this paper is to present the case of two patients with splenic pseudoaneurysm.
Case reports: The first case we present is a 26-year-old male with a history of idiopatic pancreatitis, pancreatic abscess and colonic fistula 3 years prior. The second case is a 20-year-old male with a history of chronic kidney disease with peritoneal dialysis interrupted due to fungal (Candida albicans) peritonitis. Both patients presented with signs of lower gastrointestinal bleeding. Endoscopic examinations (upper endoscopy and colonoscopy) were inconclusive. Tomographic studies showed the lesion. Arteriography with embolization was performed and was satisfactory in one case and partially satisfactory in the other case. Surgery was done with proximal and distal ligation of the lesion with splenectomy. Postoperative evolution was satisfactory. During the follow-up for 6 and 12 months, neither patient has presented signs of recurrent bleeding.
Conclusions: This is a very rare lesion usually presenting after a history of pancreatitis or abdominal trauma. This lesion must be ruled out in patients with obscure gastrointestinal bleeding. Arteriography with embolization is the best diagnostic and probably therapeutic procedure. Surgery is warranted for hemodynamically unstable patients, embolization failure or rebleeding.

REFERENCES

1. Agrawal GA, Johnson PT, Fishman EK. Splenic artery aneurysms and pseudoaneurysms: clinical distinctions and CT appearances. AJR Am J Roentgenol 2007;188:992-999.

2. Piffaretti G, Tozzi M, Lomazzi C, Rivolta N, Riva F, Caronno R, et al. Splenic artery aneurysms: postembolization syndrome and surgical complications. Am J Surg 2007;193:166-170.

3. Tessier DJ, Stone WM, Fowl RJ, Abbas, MA, Andrews, JC, Bower TC, et al. Clinical features and management of splenic artery pseudoaneurysm: case series and cumulative review of literature. J Vasc Surg 2003;38:969-974.

4. Walker TG, Geller SC, Waltman AC. Splenic artery pseudoaneurysms causing lower gastrointestinal hemorrhage. AJR Am J Roentgenol 1988;150:433-434.

5. Hong GS, Wong CY, Nambiar R. Massive lower gastrointestinal haemorrhage from a splenic artery pseudoaneurysm. Br J Surg 1992;79:174.

6. Keane TE, Tait P, Tanner AR, Peel AL. Profuse rectal bleeding—an unusual cause. Dis Colon Rectum 1988;31:989-990.

7. Udd M, Leppäniemi AK, Bidel S, Keto P, Roth WD, Haapiainen RK. Treatment of bleeding pseudoaneurysms in patients with chronic pancreatitis. World J Surg 2007;31:504-510.

8. Bergert H, Hinterseher I, Kersting S, Leonhardt J, Bloomenthal A, Saeger HD. Management and outcome of hemorrhage due to arterial pseudoaneurysms in pancreatitis. Surgery 2005;137:323-328.

9. Frey CF. Pancreatic pseudocyst—operative strategy. Ann Surg 1978;188:652-662.

10. Waslen T, Wallace K, Burbridge B, Kwauk S. Pseudoaneurysm secondary to pancreatitis presenting as GI bleeding. Abdom Imaging 1998;23:318-321.

11. Balsarkar DJ, Joshi MA. Rupture of splenic artery pseudoaneurysm presenting with massive upper GI bleeding. Am J Surg 2002;183:197-198.

12. Macía M, Pulido-Duque JM, Hortal L, Vega N, García-Medina J, Ortiz E, et al. Percutaneous embolization of splenic artery pseudoaneurysm as a treatment of hemoperitoneum in a CAPD patient. Perit Dial Int 1993;13:157-159.

13. Galeano C, Liaño F, Tenorio MT, Rivera M, Sánchez J, Haurie J, et al. Mycotic pseudoaneurysms in a CAPD patient. Nephrol Dial Transplant 2007;22:669-670.

14. Heggtveit HA. Rupture of an aneurysm of the splenic artery: an unusual cause of massive gastric hemorrhage. Can Med Assoc J 1963;88:1290-1294.

15. Conde-Muiño R, Villegas-Herrera T, Álvarez-Morán L, Garrote-Lara D, Ferrón-Orihuela JA. Haemosuccus pancreaticus caused by a splenic artery pseudoaneurysm. Cir Esp 2008;84:280-282.

16. Yattoo GN, Khuroo MS, Wani NA, Wani KA, Bhat FA. Haemosuccus pancreaticus: a clinical challenge. J Gastroenterol Hepatol 1999;14:172-175.

17. Shahani RB, Bijlani RS, Dalvi AN, Shah HK, Samsi AB. Massive upper gastrointestinal haemorrhage due to direct visceral erosion of splenic artery aneurysm. J Postgrad Med 1994;40:220-222.

18. Ammori BJ, Madan M, Alexander DJ. Haemorrhagic complications of pancreatitis: presentation, diagnosis and management. Ann R Coll Surg Engl 1998;80:316-325.

19. Tulsyan N, Kashyap VS, Greenberg RK, Sarac TP, Clair DG, Pierce G, et al. The endovascular management of visceral artery aneurysms and pseudoaneurysms. J Vasc Surg 2007;45:276-283.

20. Patel AG, Reber PU, Fielding G. Laparoscopic management of upper GI bleeding from a splenic artery pseudoaneurysm. Eur J Surg 2000;166:581-582.

21. de Perrot M, Berney T, Bühler L, Delgadillo X, Mentha G, Morel P. Management of bleeding pseudoaneurysms in patients with pancreatitis. Br J Surg 1999;86:29-32.