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• W2913125409 abstract "Gastric bleeding due to collateral arteries from a congenital absence of the splenic artery is very rare. To the best of our knowledge it has been reported only three other times in literature. Treatment of these difficult to visualize vessels can be challenging as the unknown vascular anatomy can lead to an unsure diagnosis and hesitant treatment during emergent endoscopy. We present a case of massive gastrointestinal bleeding from an aberrant artery in the fundus in the absence of the splenic artery treated with coli embolization and endoscopic ultrasound (EUS) guided placement of over the scope clip (OTSC). A 66-year-old male presented with hematemesis and hemorrhagic shock. Within the last eight years, the patient had undergone previous endoscopies for hematemesis and melena without evidence of active GI bleeding at time of endoscopy. However, the presence of thickened folds in the fundus, suggestive of isolated gastric varices, had been noted but no further investigations performed. Emergent upper endoscopy this time revealed a large clot within the fundus that was unable to be cleared. Blakemore tube was placed to while the patient was further stabilized. Computerized tomography (CT) showed no evidence of cirrhosis, portal hypertension or splenic vein thrombus though it did show an ongoing arterial bleed in the fundus around the gastric balloon of the Blakemore tube. Visceral angiogram found an absence of the splenic artery with collateral flow of short gastric vessels. The left and right gastric arteries were hypertrophied and there was active bleeding at the left gastric branch vessel at the fundal level. Coil embolization at the mid-distal left gastric artery resulted in successful hemostasis. Over the next few days the patient remained hemodynamically stable but had a down trending hemoglobin level. In hopes to localize and direct endoscopic intervention an upper endoscopy with EUS was performed. There was an area of tortuous and thicken folds with ulceration in the fundus with evidence of oozing and an OTSC was placed. The patient remained stable and was discharged three days later. This case describes a rare condition of a congenital absence of the splenic artery that lead to massive gastrointestinal hemorrhage from aberrant arterial vessels. Quick diagnosis and the use of both endoscopic and interventional radiologic treatments resulted in a successful outcome without the need for surgery." @default.
• W2913125409 created "2019-02-21" @default.
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• W2913125409 date "2017-10-01" @default.
• W2913125409 modified "2023-09-26" @default.
• W2913125409 title "Congenital Absence of the Splenic Artery Presenting as Massive Gastric Hemorrhage" @default.
• W2913125409 doi "https://doi.org/10.14309/00000434-201710001-01884" @default.
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