Splenic Artery Pseudoaneurysm Causing Delayed Hematemesis After Total Gastrectomy With D2 Lymphadenectomy

Delayed postoperative hemorrhage after total gastrectomy is rare and may occur in the absence of an identifiable intraluminal bleeding source. Vascular complications, including splenic artery pseudoaneurysm, represent an uncommon but potentially life-threatening etiology. We report the case of a 67-year-old woman who underwent open total gastrectomy with Roux-en-Y reconstruction and standard D2 lymphadenectomy for gastric adenocarcinoma. Fourteen days postoperatively, she presented with acute hematemesis and hemodynamic instability. Endoscopic and surgical exploration failed to identify a bleeding source. Computed tomography angiography revealed a splenic artery pseudoaneurysm, which was successfully managed with endovascular stent placement. Splenic artery pseudoaneurysm should be considered in patients presenting with delayed bleeding after gastrectomy when conventional investigations are inconclusive. Computed tomography angiography is essential for diagnosis, and endovascular therapy is a safe and effective first-line treatment.