Splenic Artery Pseudoaneurysm With Fistulization to the Transverse Colon: A Case Report

Splenic artery pseudoaneurysms (SAPs) are rare occurrences, most commonly secondary to pancreatitis, abdominal trauma, or postoperative/iatrogenic causes. The most common presenting symptom is abdominal pain, but it may also be hematochezia, melena, or hematemesis. SAP rupture or fistulation causes massive hemorrhage leading to hemorrhagic shock and possible death if left untreated. The timely diagnosis and treatment of SAPs are therefore crucial in managing these patients. Here, we present a case of a female in her 80s presenting with rectal bleeding, diagnosed with SAP with fistulization to the transverse colon as seen on contrasted abdominopelvic CT. She was treated with endovascular embolization, which successfully resolved the bleeding, and subsequent splenectomy and splenic flexure colectomy. The patient's postoperative course was complicated by urinary retention due to presumed UTI, left-sided pleural effusion, mitral regurgitation, and tricuspid regurgitation. Once the complications resolved, the patient did well with symptom resolution. Early diagnosis is crucial for the management of these patients. Due to the nonspecific presentation, a high level of suspicion should prompt further evaluation to prevent adverse outcomes. Fistulization of SAPs to surrounding structures could lead to complications, as was seen with this patient. However, endovascular embolization of the SAP with subsequent segmental resection of the involved colon proved to be a successful treatment.