J Korean Surg Soc.  2009 Jul;77(1):64-68. 10.4174/jkss.2009.77.1.64.

Proximal Splenic Artery Pseudoaneurysm after Radical Subtotal Gastrectomy

• Jung H
• Choi SH
• Shin SH
• An JY
• Choi MG
• Noh JH
• Sohn TS
• Bae JM
• Kim S

• KMID: 1464945
• DOI: http://doi.org/10.4174/jkss.2009.77.1.64

Abstract

Splenic artery pseudoaneurysm (SAP) is a very rare case, postoperatively. SAP originates from many causes such as complication of chronic pancreatitis in adults and blunt abdominal trauma in children. SAP related to surgery may result from direct tissue injury during operation. Urgent angiography is helpful in diagnoses and life-saving procedures as the endovascular embolization simultaneously. However, endovascular management is not a definite treatment modality in patients previously operated on because the blood supply of remaining organs will be insufficient after embolization. In this paper, we report a rare case that is proximal splenic artery pseudoaneurysm after radical subtotal gastrectomy in a 63-year-old male patient with early gastric cancer, as well as a brief review.

Keyword

Splenic artery pseudoaneurysm; Radical subtotal gastrectomy

MeSH Terms

Adult
Aneurysm, False
Angiography
Child
Gastrectomy
Humans
Male
Middle Aged
Pancreatitis, Chronic
Splenic Artery
Stomach Neoplasms

Figure

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  Fig. 1 Abdominal CT scan showed intraluminal hematoma in the remnant stomach with excessive fibrosis at previous operated portion.

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  Fig. 2 Ergent Esophagogastroduodenoscopy (EGD) showed huge aggregated blood clot at proximal area from anastomosis and greater curvature portion without active bleeding evidence.

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  Fig. 3 (A) Pseudoaneurysmal appearance was identified at proximal splenic artery in the near common hepatic artery. (B) Extravasated contrast media with backflow into remnant stomach portion. (C) Endovascular embolization by coiling.

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  Fig. 4 Non-clotting blood was observed in remaining stomach, and ischemic appearance was identified from anterior wall to lesser curvature area in follow up EGD after embolization.

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