Management of Large Splenic Artery Pseudoaneurysm Presenting with Gastrointestinal Bleeding

Splenic artery pseudoaneurysms are rare but life-threatening complications of chronic pancreatitis (CP). Their management often requires a tailored approach to address the vascular abnormality while minimizing patient morbidity. We report the case of a 59-year-old Caucasian female patient with a history of chronic alcohol consumption who presented to the Emergency Department at Laiko General Hospital of Athens with complaints of melena and diffuse abdominal pain. An endoscopy revealed a Forrest 2b lesion and a pulsatile bulge at the posterior stomach wall. Due to the pulsatile bulge, the lesion was not intervened upon during endoscopy, as it was suspected to represent an underlying vascular abnormality. Initially presumed to be an ulcer secondary to chronic alcohol use, the lesion prompted further evaluation with a contrast-enhanced CT scan. Imaging confirmed a splenic artery pseudoaneurysm measuring 4.09 x 4.58 cm and revealed evidence of CP. Endovascular embolization of the pseudoaneurysm was performed, achieving complete occlusion and leading to a favorable outcome. The patient's postoperative course was uneventful, with stable laboratory findings and functional splenic tissue on follow-up imaging. Over a six-month follow-up, serial imaging confirmed the absence of relapse or complications.This case underscores the importance of individualized care and highlights the role of interventional radiology as a primary modality for managing pseudoaneurysms without hemorrhage. A minimally invasive approach can achieve effective resolution while preserving splenic function.