Gastric hemorrhage as a late complication of splenic artery aneurysm repair: a dramatic way to vent one's spleen

Massive bleeding from gastric submucosal arterial collaterals secondary to splenic artery thrombosis: A case report

BACKGROUND

Gastric submucosal arterial collaterals (GSAC) secondary to splenic artery occlusion is an extraordinary rare and potentially life-threatening cause of acute upper gastrointestinal bleeding. Here, we report a case of massive bleeding from GSAC successfully treated by means of a multidisciplinary minimally invasive approach.

CASE SUMMARY

A 60-year-old non-cirrhotic gentleman with a history of arterial hypertension was admitted due to hematemesis. Emergent esophagogastroduodenoscopy revealed pulsating and tortuous varicose shaped submucosal vessels in the gastric fundus along with a small erosion overlying one of the vessels. In order to characterize the fundic lesion, pre-operative emergent computed tomography-angiography was performed showing splenic artery thrombosis (SAT) and tortuous arterial structures arising from the left gastric artery and the left gastroepiploic artery in the gastric fundus. GSAC was successfully treated by means of a minimally invasive step-up approach consisting in endoscopic clipping followed by transcatheter arterial embolization (TAE).

CONCLUSION

This was a previously unreported case of bleeding GSAC secondary to SAT successfully managed by means of a multidisciplinary minimally invasive approach consisting in endoscopic clipping for the luminal bleeding control followed by elective TAE for the definitive treatment.

Upper gastrointestinal bleeding related to an eroded gastrosplenic collateral lately after splenic artery embolization

Background

Upper gastrointestinal, non-variceal haemorrhage can be related to various etiologies, including peptic ulcer, neoplasm, gastritis, Dieulafoy lesions and other, rare underlying diseases. Here, we describe another, yet unreported etiology of gastric bleeding.

Case presentation

A 49-year-old man presented with melena; gastroscopy revealed blood in the stomach without active bleeding source. Computed tomography angiography demonstrated a cluster of enlarged gastrosplenic arterial collaterals in the gastric wall and coils in the splenic artery, related to an embolization procedure 30-years ago for splenic trauma. Definitive treatment included catheter-directed glue embolization of the left gastric artery and the enlarged gastrosplenic collaterals. The postinterventional course was uneventful and no recurrence of upper gastrointestinal bleeding was noted after 6 months of follow-up.

Conclusions

Upper gastrointestinal bleeding associated with eroded gastrosplenic collaterals, related to previous splenic artery embolization, can be successfully treated with glue-embolization.

Transcatheter embolization of extensive left gastric artery collaterals presenting with massive upper gastrointestinal bleed

We report a case of extensive left gastric artery collaterals that were formed in the region of gastric fundus due to splenic artery occlusion and resulted in massive hematemesis. These collaterals were thought to be portosystemic collaterals related to portal hypertension during upper endoscopy study and single-phase venous computed tomography studies. The collaterals were treated by transcatheter endovascular coil embolization. Our case highlights the importance of recognizing and differentiating left gastric artery collaterals from gastric venous varices as a cause of hematemesis since the treatment approach for each condition is totally different. It also introduces the feasibility of percutaneous left gastric artery embolization as a treatment for this condition, without the need for surgical splenectomy and partial gastrectomy which have a higher mortality and morbidity.