| Popis: |
Visceral artery pseudoaneurysm is uncommon. The splenic artery is the most commonly affected visceral artery, and it usually develops secondary to chronic pancreatitis. Only 20 cases of giant pseudoaneurysms, defined as psedoaneurysms equal to, or greater than, 5 cm in size, have been reported until now. In this case, hemosuccus pancreaticus which means fistula to pancreatic duct, and hemorrhage in stomach, duodenum, or adjacent gastrointestinal track which result from fistula to gastrointestinal track are two main symptoms that develop. Both of them require operation or transcatheter embolization. We describe the case of a giant splenic pseudoanerysmal rupture with gastric fistula in a patient who presented with hematemesis. A 54 year old man who were receiving outpatient treatment of chronic pancreatitis and alcoholic cirrhosis, went ER for the treatment of hematemesis. In EGD, 6 cm sized mass with normal mucosa was observed in posterior wall of stomach. And there is bleeding from ulcer in the central part of the mass (Fig. 1). Attempt for hemostasis by epinephrine injection met with failure. In Abdominal CT, 2.6 cm sized splenic artery aneurysm with 6.8cm sized pseudoaneurysm was seen at pancreas tail, that compressed posterior wall of high body, stomach (Fig. 2). The patient underwent arteriography, which confirmed the ruptured pseudoaneurysm of splenic artery. The pseudoaneurysm was embolized using metallic coil(Fig. 3). As bleeding didn't stop after embolization, surgical intervention was performed. After operation, bleeding was not ongoing any more. |
