Fatal Recurrent Splenic Artery Pseudoaneurysm Rupture Despite Prior Successful Embolization in Alcohol-Associated Chronic Pancreatitis: A Case Report.

Background and Clinical Significance: Splenic artery pseudoaneurysm (SAP) is a rare but life-threatening complication of chronic pancreatitis. Although endovascular embolization achieves high technical success, recurrence and delayed rupture may occur, particularly in patients with ongoing pancreatic inflammation or alcohol use disorder (AUD). Case Presentation: A 47-year-old woman with alcohol-associated chronic pancreatitis presented with hematochezia, melena, and syncope. CT angiography revealed a 3.6 cm SAP adjacent to a 4.2 cm pancreatic head pseudocyst, and she underwent successful coil embolization. Despite initial stability, she relapsed into heavy alcohol use, experienced recurrent pancreatitis flares, and developed progressive multisystem comorbidities. Surveillance imaging up to three months post-embolization showed pseudocyst fluctuations without early recanalization, but long-term follow-up lapsed. Eight months after embolization, she presented in hemorrhagic shock from recurrent SAP rupture and died despite massive transfusion and emergent splenic artery ligation.

Conclusions

Fatal SAP rupture may occur months after technically successful embolization. Sentinel bleeding, AUD relapse, and progressive systemic decline are critical warning signs. Structured post-embolization imaging and multidisciplinary management are essential to improve long-term outcomes.