Martino A, Di Serafino M, Zito FP, Maglione F, Bennato R, Orsini L, Iacobelli A, Niola R, Romano L, Lombardi G. Massive bleeding from gastric submucosal arterial collaterals secondary to splenic artery thrombosis: A case report. World J Gastroenterol 2022; 28(37): 5506-5514 [PMID: 36312836 DOI: 10.3748/wjg.v28.i37.5506]
Corresponding Author of This Article
Alberto Martino, MD, Staff Physician, Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Via Antonio Cardarelli 9, Napoli 80131, Italy. albertomartinomd@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Oct 7, 2022; 28(37): 5506-5514 Published online Oct 7, 2022. doi: 10.3748/wjg.v28.i37.5506
Massive bleeding from gastric submucosal arterial collaterals secondary to splenic artery thrombosis: A case report
Alberto Martino, Marco Di Serafino, Francesco Paolo Zito, Franco Maglione, Raffaele Bennato, Luigi Orsini, Alessandro Iacobelli, Raffaella Niola, Luigia Romano, Giovanni Lombardi
Alberto Martino, Francesco Paolo Zito, Raffaele Bennato, Luigi Orsini, Giovanni Lombardi, Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
Marco Di Serafino, Luigia Romano, Department of General and Emergency Radiology, AORN “Antonio Cardarelli”, Napoli 80131, Italy
Franco Maglione, Department of Radiology, Sanatrix Clinic, Napoli 80127, Italy
Alessandro Iacobelli, Department of Pathology, AORN “Antonio Cardarelli”, Napoli 80131, Italy
Raffaella Niola, Department of Interventional Radiology, AORN “Antonio Cardarelli”, Napoli 80131, Italy
Author contributions: Martino A was responsible for the conception of the paper, execution of the endoscopic procedures, drafting of the article, interpretation of the data and final approval of the article; Di Serafino M was responsible for conception of the paper, execution of the diagnostic radiological examinations, drafting of the article and final approval of the article; Zito FP was responsible for the conception of the paper, drafting of the article, interpretation of data and final approval of the article; Maglione F and Niola R were responsible for execution of the interventional radiological procedures, drafting of the article, interpretation of the data and final approval of the article; Bennato R, Orsini L and Iacobelli A were responsible for drafting of the article, interpretation of data and final approval of the article; Romano L and Lombardi G were responsible for the analysis and interpretation of data, revision of the manuscript for important intellectual content and final approval of the article.
Informed consent statement: Informed consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alberto Martino, MD, Staff Physician, Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Via Antonio Cardarelli 9, Napoli 80131, Italy. albertomartinomd@gmail.com
Received: June 18, 2022 Peer-review started: June 18, 2022 First decision: July 11, 2022 Revised: July 17, 2022 Accepted: September 8, 2022 Article in press: September 8, 2022 Published online: October 7, 2022 Processing time: 102 Days and 21.4 Hours
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.
Core Tip: Gastric submucosal arterial collaterals (GSAC) secondary to splenic artery occlusion is an extremely rare cause of severe non variceal upper gastrointestinal bleeding. Herein, we describe a previously unreported case of massive bleeding from GSAC secondary to splenic artery thrombosis effectively treated by endoscopic mechanical hemostasis followed by endovascular embolization.
