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Posttraumatic splenic artery aneurysm presenting as occult gastrointestinal bleeding
Robert Koch1, Ivo Graziadei, Heinz Zoller
1Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Innsbruck, Innsbruck, Austria. robert.koch@uibk.ac.at
Wiener Klinische Wochenschrift
|November 8, 2003
Summary
A rare cause of gastrointestinal bleeding, a splenic artery aneurysm (SAA) was diagnosed in a patient with persistent bleeding. Successful treatment via coil occlusion resolved the hemorrhage, highlighting SAA as a critical consideration in obscure bleeding cases.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Diagnostic Imaging
Background:
- Gastrointestinal bleeding (GIB) can be challenging to diagnose, especially when standard endoscopic evaluations fail to identify a source.
- Aneurysms, particularly splenic artery aneurysms (SAAs), are uncommon causes of GIB but can present with severe hemorrhage.
Observation:
- A 53-year-old male experienced 19 months of recurrent GIB without an identifiable source on repeated upper and lower endoscopies.
- A massive hemorrhage led to referral, where gastroscopy revealed a gastric wall tumor.
- Advanced imaging, including endoscopic ultrasound and CT angiography, identified a thrombosed SAA.
Findings:
- Arteriography confirmed the SAA diagnosis.
- The SAA was successfully treated by endovascular occlusion using coils.
- The patient recovered fully with no further GIB episodes post-procedure.
Implications:
- Splenic artery aneurysms are a rare but significant cause of obscure GIB.
- Diagnostic algorithms for refractory GIB should consider vascular anomalies like SAAs.
- Endovascular techniques offer a minimally invasive and effective treatment for SAAs causing GIB.