A CLINICAL CASE OF A RUPTURED SPLENIC ARTERY PSEUDOANEURYSM LEADING TO GASTROINTESTINAL BLEEDING: DIAGNOSIS AND MANAGEMENTCORONARY SYNDROME
Agurina N.V.1,2, Zyablova E.I.1,2, Shevchenko E.G.1,2, Porkhanov V.A.1,2
1 - Research Institute , S.V. Ochapovsky Krasnodar Regional Hospital No. 1.
2 - Kuban State Medical University. Krasnodar, Russia.
|
P |
urpose. To demonstrate the role of multispiral computed tomography (MSCT) in identifying a complicated pseudoaneurysm of the splenic artery as a rare but life-threatening source of gastrointestinal bleeding.
Material and methods. We present a case of a 50-year-old patient with clinical symptoms of gastrointestinal bleeding. A multiphase CT scan showed a pseudoaneurysm of the splenic artery complicated by retroperitoneal bleeding and bleeding into the main pancreatic duct.
Results. By means of multispiral computed tomography it is possible to detect pseudoaneurysm of the splenic artery and associated complications. In our case computed tomography revealed a false aneurysm of the splenic artery complicated by rupture into the retroperitoneal space and the formation of an arterio-pancreatic fistula, and endoscopic examination confirmed bleeding from the main pancreatic duct. Based on the results of the CT scan, selective angiography was performed with embolization of a pseudoaneurysm of the splenic artery.
Discussion. Upper gastrointestinal bleeding in patients with chronic pancreatitis can rarely be caused by bleeding into the pancreatic duct due to a ruptured pseudoaneurysm. The main diagnostic methods are upper gastrointestinal endoscopy, contrast-enhanced computed tomography, and selective angiography of the celiac trunk and superior mesenteric artery. CT angiography is the method of choice for diagnosing and planning management of splenic artery pseudoaneurysms. Endovascular treatment with low morbidity and high survival is an alternative to surgical treatment of splenic artery pseudoaneurysms.
Conclusions. The use of contrast-enhanced computed tomography in the emergency setting allows to identify with high accuracy and in the shortest possible time the source of the gastrointestinal bleeding, as well as obtain complete diagnostic information about the localization of the pseudoaneurysm and its associated complications, which determined further management of the patient, i.e. minimally invasive radical surgery.
Keywords: computed tomography, CT angiography, splenic artery pseudoaneurysm, angiography.
Corresponding author: Agurina N.V., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Agurina N.V., Zyablova E.I., Shevchenko E.V., Porhanov V.A. A clinical case of a ruptured splenic artery pseudoaneurysm leading to gastrointestinal bleeding: diagnosis and management. REJR 2023; 13(3):162-169. DOI: 10.21569/2222-7415-2023-13-3-162-169.
Received: 28.06.23 Accepted: 08.08.23