title: Management of pseudoaneurysm of the splenic artery: report of two cases.
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.
  
  
  METHODS
  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.
authors.affiliation: Servicio de Gastrocirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, DF, Mexico. guillermo_1113.bao@hotmail.com
authors.forename: Guillermo Alberto
authors.initials: GA
authors.lastname: Ballinas-Oseguera
authors.forename: José Luis
authors.initials: JL
authors.lastname: Martínez-Ordaz
authors.forename: Tania Gisel
authors.initials: TG
authors.lastname: Sinco-Nájera
authors.forename: Carmen
authors.initials: C
authors.lastname: Caballero-Luengas
authors.forename: Jorge
authors.initials: J
authors.lastname: Arellano-Sotelo
authors.forename: Roberto
authors.initials: R
authors.lastname: Blanco-Benavides
mesh_terms: D000038:Abscess / Q000150:complications; D000328:Adult; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D058365:Candidiasis, Invasive / Q000150:complications; D002908:Chronic Disease; D003108:Colonic Diseases / Q000150:complications; D004621:Embolization, Therapeutic; D005402:Fistula / Q000150:complications; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000150:complications; D007412:Intestinal Fistula / Q000150:complications; D007676:Kidney Failure, Chronic / Q000150:complications; D008026:Ligation; D008297:Male; D010195:Pancreatitis / Q000150:complications; D010530:Peritoneal Dialysis / Q000009:adverse effects; D010538:Peritonitis / Q000150:complications; D011859:Radiography; D013156:Splenectomy; D013157:Splenic Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D055815:Young Adult