When Ascites Is Not Ascites!

Abstract

Patients presenting with ascites should be properly evaluated to differentiate potential etiologies. Then, based on the evaluation, we can tailor more accurate treatment plans for patients. Cirrhosis is the most common cause, and others include cancer, heart failure, and, in our case, rarely a visceral artery rupture. Rupture of the splenic artery aneurysm can be lethal and should be considered as a possible differential in a patient with no previous history of heart failure, cancer, or cirrhosis. Our patient was identified after an initial misdiagnosis of possible ascites secondary to cirrhosis. However, input from an interventional radiologist led to proper identification and tailored management. Early treatment is crucial to prevent complications, including death.

Keywords: aneurysm; ascites; embolization; hemorrhagic shock; ruptured; splenic artery; splenic artery aneurysm; visceral artery; visceral artery aneurysms; visceral artery rupture.

Figure 1. Splenic artery aneurysm (short arrow) and hemorrhage (long arrow)

Figure 2. Angiogram showing two splenic artery aneurysms. The right arrow is the ruptured splenic artery aneurysm

Figure 3. Statue-post coiling of the splenic artery aneurysm