Upper gastrointestinal hemorrhage due to splenic artery pseudoaneurysm combined with pancreatic pseudocyst recurrence: A case report

Intracapsular hemorrhage occurs occasionally in acute pancreatitis complicated with pseudocyst that can be managed using laparoscopic gastric cyst anastomosis and drainage. However, cyst recurrence many years later and secondary splenic artery pseudoaneurysm rupture and hemorrhage leading to bloody vomiting and syncope are uncommonly reported. A woman in her late 40s was admitted for bloody vomiting, melena, anemia, and syncope. She underwent laparoscopic gastric cyst anastomosis and drainage for severe acute pancreatitis 3 years ago. Gastroscopy identified a bleeding gastric vascular malformation. Metal clips were used for endoscopic hemostasis. Abdominal enhanced computed tomography revealed a cystic lesion in the tail of the pancreas (4.2 × 3.9 cm) connected with the stomach wall and a splenic artery pseudoaneurysm in the cyst. Splenic artery pseudoaneurysm embolization was performed. The patient remains asymptomatic 2 years after embolization. Percutaneous selective embolization of a splenic artery pseudoaneurysm may be the preferred choice for patients with a pancreatic pseudocyst complicated by rupture and hemorrhage of the splenic artery pseudoaneurysm in the pancreatic pseudocyst. Clinicians should be alert regarding the possibility of recurrence after prior drainage, highlighting the importance of long-term follow-up.