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Case Reports
. 2022 Oct 7;28(37):5506-5514.
doi: 10.3748/wjg.v28.i37.5506.

Massive bleeding from gastric submucosal arterial collaterals secondary to splenic artery thrombosis: A case report

Alberto Martino  1 , Marco Di Serafino  2 , Francesco Paolo Zito  3 , Franco Maglione  4 , Raffaele Bennato  3 , Luigi Orsini  3 , Alessandro Iacobelli  5 , Raffaella Niola  6 , Luigia Romano  2 , Giovanni Lombardi  3
Affiliations
Case Reports

Massive bleeding from gastric submucosal arterial collaterals secondary to splenic artery thrombosis: A case report

Alberto Martino et al. World J Gastroenterol. .

Abstract

Background: Gastric submucosal arterial collaterals (GSAC) secondary to splenic artery occlusion is an extraordinary rare and potentially life-threatening cause of acute upper gastrointestinal bleeding. Here, we report a case of massive bleeding from GSAC successfully treated by means of a multidisciplinary minimally invasive approach.

Case summary: A 60-year-old non-cirrhotic gentleman with a history of arterial hypertension was admitted due to hematemesis. Emergent esophagogastroduodenoscopy revealed pulsating and tortuous varicose shaped submucosal vessels in the gastric fundus along with a small erosion overlying one of the vessels. In order to characterize the fundic lesion, pre-operative emergent computed tomography-angiography was performed showing splenic artery thrombosis (SAT) and tortuous arterial structures arising from the left gastric artery and the left gastroepiploic artery in the gastric fundus. GSAC was successfully treated by means of a minimally invasive step-up approach consisting in endoscopic clipping followed by transcatheter arterial embolization (TAE).

Conclusion: This was a previously unreported case of bleeding GSAC secondary to SAT successfully managed by means of a multidisciplinary minimally invasive approach consisting in endoscopic clipping for the luminal bleeding control followed by elective TAE for the definitive treatment.

Keywords: Acute upper gastrointestinal bleeding; Case report; Gastric submucosal arterial collaterals; Non variceal upper gastrointestinal bleeding; Splenic artery thrombosis; Upper gastrointestinal bleeding.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Emergent esophagogastroduodenoscopy: Retroflexed view of the gastric fundus showing varicose-shaped submucosal vessels with a small erosion (arrow).
Figure 2
Figure 2
Emergent computed tomography angiography: Axial view. A: Arterial phase showing complete splenic artery thrombosis (arrow); B: Arterial phase curved-multiplanar reconstruction showing splenic artery collateral vessels (yellow arrows) with an arterial cluster at the gastric fundus (arrowhead) arising from the left gastric artery (black arrow) and the left gastroepiploic artery (red arrow).
Figure 3
Figure 3
Therapeutic esophagogastroduodenoscopy. A: Spurting active bleeding of the gastric submucosal arterial collaterals after first endoclip application; B: Successful mechanical hemostasis achievement.
Figure 4
Figure 4
Operative angiography showing a cluster of collateral arterial vessels emerging from the left gastric artery (red arrow) and the left gastroepiploic artery (yellow arrow) projecting into the gastric fundus. It also shows previously placed endoclips on the submucosal collateral arteries of the gastric fundus without active contrast extravasation (arrowhead).
Figure 5
Figure 5
Post-operative computed tomography angiography: Axial view showing collateral arteries of the gastric fundus treated by endoscopic clipping plus microspheres embolization (red arrow) and splenic infarction (yellow arrow).
See this image and copyright information in PMC

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