A Case of Gastric Bleeding from Gastric Collaterals and Varices Secondary to Embolization of Splenic Artery

Takashi Yokoyama, Akihiko Watanabe, Kazuhiro Migita, Kenji Nakagawa, Takashi Inoue, Tomohide Mukogawa, Takao Ohyama and Hirofumi Ishikawa

Department of Surgery, Nara Prefectural Nara Hospital

A 46-year-old woman reporting 4 weeks of general fatigue was found in blood tests to have severe anemia of 2.9 g/dl, necessitating a blood transfusion. Five years earlier, a traumatic spleen injury had necessitated transcatheter arterial embolization (TAE). Endoscopic examination showed a submucosal tumor with dilated vessels in the fornix of the gastric posterior wall. Abdominal enhanced computed tomography (CT) showed an unclear submucosal tumor and thickened gastric wall with abundant blood flow adhering to the spleen. Because the diagnosis was imprecise, we conducted abdominal angiography, finding marked dilation of the left inferior phrenic artery, for which angiography showed a round hypervascular lesion about 10 cm in size via the gastric fornix, indicating the spleen, with the other part of the spleen fed by the splenic artery. We diagnosed the condition as intragastric bleeding from gastric collaterals and varices caused by the dilated left inferior phrenic artery. Due to the high probability that TAE for the left inferior phrenic artery has caused the intra-abdominal abscess, we ligated the left inferior phrenic artery, leaving the left gastric artery, and conducted a splenectomy. Endoscopic examination 6 months after surgery showed no dilated vessels. Angiography was thus very useful in diagnosis and treatment selection. Intragastric bleeding from gastric collaterals and varices after splenic artery embolization is very rare, to our knowledge.

Key words
gastric bleeding, splenic artery occlusion, collateral

Reprint requests
Takashi Yokoyama Department of Surgery, Hoshigaoka Koseinenkin Hospital
4-8-1 Hoshigaoka, Hirakata, 573-8511 JAPAN

Accepted
December 17, 2008

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