Rupture of a Splenic Pseudoaneurysm into the Transverse Colon

Masahiko Kawaguchi, Masanari Shimada, Masato Fukumoto, Hideaki Kato, Toru Watanabe and Hirofumi Sato

Department of Surgery, Yokohama Sakae Kyosai Hospital

A 45-year-old Japanese man sought confirmation of his condition after the discovery of bloody stool. He had a history of acute pancreatitis 8 years earlier, of heavy alcohol consumption and of smoking one pack of cigarettes a day. Before the first examination, he had had a few days of epigastric discomfort. He showed no signs of shock, and laboratory data showed neither anemia nor an abnormal serum amylase level. Upper gastrointestinal endoscopy showed stomach wall swelling suggesting a submucosal tumor, but no ulcer or erosion was seen. Sigmoidoscopy showed fresh blood in the lumen but no bleeding point could be detected. Computed tomography (CT) showed a 3 cm lesion at the pancreas tail with the same enhancement as the splenic artery and attached to the transverse colon. The main pancreatic duct was calcified and dilated. The diagnosis was a ruptured splenic pseudoaneurysm into the transverse colon, necessitating aneurysmectomy with distal pancreatectomy and splenectomy, together with simultaneously resection of the colon segment adhering to the aneurysm. The postoperative period was uneventful. Colonic rupture of a splenic pseudoaneurysm is very rare disease. But tendency to rupture of pseudoaneurysm needs a definitive therapy for it at a proper time.

Key words
splenic pseudoaneurysm, colonic rupture, operation

Reprint requests
Masahiko Kawaguchi Department of Surgery, Yokohama Sakae Kyosai Hospital
132 Katsura-cho, Sakae-ku, Yokohama, 247-8581 JAPAN

Accepted
October 22, 2008

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