[Ruptured splenic artery aneurysm--a rare cause of recurrent gastrointestinal hemorrhages].

HISTORY AND CLINICAL FINDINGS: A 51-year-old asthenic patient attended the hospital with syncope, head injury, tarry stool and severe anemia. There was a history of alcohol and nicotine abuse, but no known preceding diseases of the liver or gastrointestinal tract. Except hypotension, examination of the patient did not show any further abnormalities.

DIAGNOSTIC PROCEDURE: An upper and lower endoscopy did not show any evidence of a bleeding source although the stomach was full of hematin. An abdominal ultrasound demonstrated signs of a chronic pancreatitis and a big cystic structure in the area of the pancreatic tail. Pulsed and color Doppler imaging followed by angiography led to the diagnosis of a pseudoaneurysm of the splenic artery.

TREATMENT AND COURSE: After confirming the diagnosis, a laparotomy was performed. It revealed a pseudoaneurysm arising from the splenic artery that had penetrated the stomach and caused bleeding. Resection of the aneurysm, the stomach fundus, the left pancreas and the spleen was performed. 10 days after laparotomy, the patient was discharged from hospital in a good clinical condition.

CONCLUSION

Pseudoaneurysms of the splenic artery are an uncommon cause of gastrointestinal bleeding. The most important factor in detecting a pseudoaneurysm is considering the diagnosis. It is necessary to check for a pseudoaneurysm secondary to pancreatitis with pulsed or color Doppler imaging especially if a pseudocyst was first diagnosed with abdominal ultrasound. Because of the high mortality of a pseudoaneurysm, surgical resection or interventional radiology should be done as early as possible.