Diagnostic dilemma in a case of spontaneous rupture of splenic artery pseudoaneurysm, treated successfully by endovascular coil embolization- a case report

Abstract

Ruptured pseudoaneurysm in the setting of chronic calcific pancreatitis is a rare but fatal complication. Mortality rates can be high depending upon size and site of the bleeding aneurysm, general condition of the patient and more importantly, delay in the diagnosis. We report here a case of spontaneous bleed from splenic artery pseudoaneurysm in a patient with chronic pancreatitis. In this case, diagnosis was inadvertently delayed at sub divisional hospital level where it was thought to be a case of acute on chronic pancreatitis, which is in fact a more common entity. Patient’s condition deteriorated and he was referred to our tertiary care hospital where he was diagnosed to have bleeding pseudoaneurysm with encysted hemoperitoneum. He was treated successfully by endovascular coil embolization and percutaneous drainage of encysted hemorrhagic collection. The aim of this case report is to show the diagnostic dilemma that a ruptured pseudoaneurysm can present with i.e. mimicking acute pancreatitis with pseudocyst formation. Secondly, we want to emphasize the importance of Contrast Enhanced CT with CT Angiography in patients with symptoms of acute on chronic pancreatitis. The case report also demonstrates the feasibility and safety of coil embolization as a minimally invasive management option for ruptured splenic artery pseudoaneurysm.