Kazimierz  Kordecki,Adam R.  Markowski,Andrzej Baniukiewicz,Paweł Rogalski,Vitalii Grinevych,
Hematemesis in Alcoholics: Not Always the Same Problem. A Case Report of Successful Percutaneous Arterial Embolization of Spontaneously Ruptured Splenic Artery Aneurysm Causing Hematemesis, Hematochezia and Hemodynamic Instability
Surgical Case Reports
2019
2613-5965
http://dx.doi.org/10.31487/j.SCR.2019.05.02
https://www.sciencerepository.org/hematemesis-in-alcoholics-not-always-the-same-problem-a-case-report-of-successful-percutaneous-arterial-embolization-of-spontaneously-ruptured-splenic-arter_SCR-2019-5-102 
Abstract: The manuscript presents a rare case of overt upper gastrointestinal bleeding initially manifesting as coffee
ground vomiting, in a patient who had negative esophagogastroduodenoscopy performed a few hours
before. Over the first 30 minutes in the Emergency Department, the patient developed an episode of
hematemesis and hematochezia with hemodynamic instability. To identify the source of bleeding, contrastenhanced computed tomography was performed, which revealed a small aneurysm in the central part of the
splenic artery with signs of intrapancreatic rupture. Re-esophagogastroduodenoscopy revealed active
bleeding from the papilla of Vater and urgent selective angiography of the celiac trunk confirmed active
extravasation of the contrast material into the main pancreatic duct. Successful embolization of the bleeding
vessel was obtained by placing two coils in the aneurysm sac and the splenic artery.
The presented clinical case draws attention to a rare case of spontaneously ruptured splenic artery aneurysm
causing visible only periodically hemosuccus pancreaticus, progressing quickly to a life-threatening
condition and requiring firm and fast multi-profile treatment.
Keywords: Negative esophagogastroduodenoscopy, overt upper gastrointestinal bleeding, hemodynamic instability, ruptured splenic artery aneurysm, arterial embolization