Splenic artery aneurysm presenting with clinical features of a bleeding gastric gastrointestinal stromal tumour

A pictorial review on clinicopathologic and radiologic features of duodenal gastrointestinal stromal tumors

Duodenal gastrointestinal stromal tumors (GISTs) are rare, and studies on their management are not sufficient. Owing to the complex anatomy of the duodenum and pancreatic head, GISTs can be misdiagnosed as pancreatic head tumors. Surgical resection is the first treatment for localized duodenal GISTs; thus, noninvasive imaging is important for the diagnosis and treatment of GISTs. Computed tomography, magnetic resonance imaging and endoscopic ultrasonography findings can be helpful for the diagnosis of duodenal GISTs and can help differentiate GISTs from other adjacent tumors.

Giant splenic artery aneurysm presenting with massive upper gastrointestinal bleeding: A case report and review of literature

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.