title: Massive Upper Gastrointestinal Bleeding from a Splenic Artery Pseudoaneurysm Caused by a Penetrating Gastric Ulcer: Case Report and Review of Literature.
abstract: BACKGROUND
  Splenic artery aneurysm and pseudoaneurysm are rare pathologies. True aneurysms are usually asymptomatic. Aneurysm rupture occurring in 2-3% of cases results in bleeding into the lesser sack, peritoneal space or adjacent organs typically presenting as abdominal pain and hemodynamic instability. In contrast, pseudoaneurysms are nearly always symptomatic carrying a high risk of rupture of 37-47% and mortality rate of 90% if untreated. Therefore, prompt diagnosis and treatment are essential in the management of patients with splenic artery pseudoaneurysm. Typical causes include pancreatitis and trauma. Rarely, the rupture of a pseudoaneurysm presents as upper gastrointestinal (UGI) bleeding. Among causes, peptic ulcer is the casuistic one.
  
  
  METHODS
  This report describes a very rare case of recurrent UGI bleeding from a splenic artery pseudoaneurysm caused by a penetrating gastric ulcer. After negative results of endoscopy and ultrasound, the diagnosis was established in CT angiography. The successful treatment consisted of surgical ligation of the bleeding vessel and suture of the ulcer with preservation of the spleen and pancreas, which is rarely tried in such situations.
  
  
  CONCLUSIONS
  The most important factor in identifying a ruptured splenic artery pseudoaneurysm as a source of GI bleeding is considering the diagnosis. UGI hemorrhage from splenic artery pseudoaneurysm can have a relapsing course providing false negative results of endoscopy and ultrasound if performed between episodes of active bleeding. In such cases, immediate CT angiography is useful in establishing diagnosis and in application of proper therapy before possible recurrence.
authors: Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland.
authors: Marcin
authors: M
authors: Sawicki
authors: Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland.
authors: Wojciech
authors: W
authors: Marlicz
authors: Clinic of Plastic, Endocrine and General Surgery, Pomeranian Medical University, Szczecin, Poland.
authors: Norbert
authors: N
authors: Czapla
authors: Clinic of Plastic, Endocrine and General Surgery, Pomeranian Medical University, Szczecin, Poland.
authors: Marek
authors: M
authors: Łokaj
authors: Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland.
authors: Michał M
authors: MM
authors: Skoczylas
authors: Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland.
authors: Maciej
authors: M
authors: Donotek
authors: Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland.
authors: Katarzyna
authors: K
authors: Kołaczyk
keywords: Aneurysm, False; Angiography; Gastrointestinal Hemorrhage; Multidetector Computed Tomography; Splenic Artery