CASE REPORT
Vascular Surgery
doi: 10.25005/2074-0581-2026-28-3-871-878
RUPTURE OF A TRUE SPLENIC ARTERY ANEURYSM WITH RECURRENT GASTRIC BLEEDING: A CASE REPORT

A.I. PANASYUK1,2, S.A. KONDRATIEV1, E.G. GRIGORYEV2,3, D.V. BELYKH4

1Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation
2Department of Hospital Surgery, Irkutsk State Medical University, Irkutsk, Russian Federation
3Irkutsk Scientific Centre of Surgery and Traumatology, Irkutsk, Russian Federation
4Irkutsk Regional Pathology Bureau, Irkutsk, Russian Federation

This article presents a case of rupture of a true splenic artery aneurysm (SAA) in a patient with a gastric fistula and recurrent bleeding. A 38-year-old man was admitted with signs of anemia secondary to gastrointestinal bleeding. Four months earlier, at a local hospital, he had undergone gastrotomy and suturing of a bleeding vessel within an ulcer of the posterior wall of the gastric body. The patient had a long history of alcohol abuse. For two weeks, he had experienced daily melena, weakness, and dizziness. There was no vomiting. On admission, the hemoglobin level was 55 g/L, erythrocyte count 2.55×10¹²/L, and hematocrit 18.2%. Fibrogastroduodenoscopy revealed a bleeding gastric ulcer. Emergency surgery was performed. Laparotomy revealed a pulsatile retrogastric hematoma, a SAA, and a defect (fistula) in the posterior wall of the stomach. Distal pancreatectomy with splenectomy was performed. The splenic artery (SA) was transected proximal to the aneurysm, followed by gastric resection. The postoperative course was uneventful. After correction of anemia, the patient was discharged. Gastric ulceration was initially and erroneously considered the source of bleeding, which determined the surgical strategy. In our case, a hybrid treatment approach consisting of endovascular occlusion of the SA followed by resection surgery after appropriate preoperative preparation would have been optimal.

Keywords: True splenic artery aneurysm, gastric fistula, recurrent bleeding, distal pancreatectomy, splenectomy, gastric resection, case report.

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Authors' information:

Panasyuk Aleksandr Iosiphovich,
Surgeon, Irkutsk Regional Clinical Hospital; Assistant Professor of the Department of Hospital Surgery, Irkutsk State Medical University
Scopus ID: 57214574623
ORCID ID: 0000-0002-1710-2762
SPIN: 2035-0170
Author ID: 246662
E-mail: pana@mail.ru

Kondratiev Sergey Aleksandrovich,
Surgeon, Irkutsk Regional Clinical Hospital
ORCID ID: 0000-0002-9542-0897
SPIN: 1283-6427
Author ID: 1103113
Е-mail: serge.lech-med7@yandex.ru

Grigoryev Evgeniy Georgievich,
Corresponding Member of the Russian Academy of Sciences, Doctor of Medical Sciences, Full Professor, Scientific Advisor, Irkutsk Scientific Centre of Surgery and Traumatology; Head of the Department of Hospital Surgery, Irkutsk State Medical University
Researcher ID: B-7280-2017
Scopus ID: 57189622130
ORCID ID: 0000-0002-5082-7028
SPIN: 7650-2129
Author ID: 805452
Е-mail: egg.irk@gmail.com

Belykh Diana Vladimirovna,
Head of the Department of General Pathology, Pathologist, Irkutsk Regional Pathology Bureau
ORCID ID: 0000-0002-9264-0827
SPIN: 7035-8959
Author ID: 1092742
Е-mail: 89246050301@bk.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Grigoryev Evgeniy Georgievich
Corresponding Member of the Russian Academy of Sciences, Doctor of Medical Sciences, Full Professor, Scientific Advisor, Irkutsk Scientific Centre of Surgery and Traumatology; Head of the Department of Hospital Surgery, Irkutsk State Medical University

664003, Russian Federation, Irkutsk, Bortsov Revolyutsii str., 1

Tel.: +7 (902) 5111027

E-mail: egg.irk@gmail.com


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