case_images: PMC11152535_01
case_images: A 57-year-old man with prior alcoholic pancreatitis presented with hematemesis. (a) Axial image from computed tomography angiography of the abdomen showing a splenic artery pseudoaneurysm (SAP) (white arrow) that fistulized to the posterior wall of the stomach (white arrowhead). (b) Coronal reconstruction from the angiography study in (a) again showing fistulization of the SAP (white arrow) to the stomach. (c) Three-dimensional volume-rendered image from the same angiography study shows to advantage the pseudoaneurysm sac (white arrow) and its relationship to the splenic artery.
case_images: JCIS-14-16-g001.jpg
case_images: PMC11152535_01_JCIS-14-16-g001.jpg
case_images: F1
case_images: Due to ongoing bleeding, he underwent computed tomography (CT) angiography of the abdomen that revealed an actively bleeding pseudoaneurysm arising from the splenic artery with fistulization to the posterior gastric wall, leading to hemorrhage into the stomach [Figure 1].
case_images: A 57-year-old man with prior alcoholic pancreatitis presented with hematemesis. (a) Digital subtraction angiographic image from selective splenic arteriography showing a splenic artery pseudoaneurysm (SAP) that is actively bleeding (white arrow) into the stomach and opacifies the gastric rugal folds (white arrowhead). (b) Digital subtraction angiographic image from the SAP coil embolization procedure confirming pseudoaneurysm occlusion (white arrow) on selective splenic arteriography. Contrast from the prior pseudoaneurysm bleeding remains in the stomach and opacifies the gastric rugal folds (black arrow).
case_images: JCIS-14-16-g002.jpg
case_images: PMC11152535_01_JCIS-14-16-g002.jpg
case_images: F2
case_images: Urgent catheter-directed coil embolization of the splenic artery pseudoaneurysm (SAP) was performed, with post-embolization angiography confirming occlusion of the pseudoaneurysm [Figure 2].
case_images: PMC11152535_02
case_images: An 80-year-old man status post Whipple procedure for pancreatic cancer presented with hematochezia. Esophagogastroduodenoscopy image of the afferent limb of the jejunum showing multiple varices (white arrows) at the choledochojejunostomy anastomosis (white arrowhead).
case_images: JCIS-14-16-g003.jpg
case_images: PMC11152535_02_JCIS-14-16-g003.jpg
case_images: F3
case_images: EGD performed at our hospital demonstrated a normal efferent jejunal limb, whereas the afferent limb was filled with blood, and the choledochojejunostomy (CDJ) site was covered by a large clot, which when dislodged revealed underlying varices as the source of bleeding [Figure 3].
case_images: An 80-year-old man status post Whipple procedure for pancreatic cancer presented with hematochezia. (a) Digital subtraction angiography image from super-selective portal venography showing a stenotic superior mesenteric vein (white arrowheads) that supplies a network of varices (arrows) in the territory of the afferent jejunal limb. (b) Digital subtraction angiography image from repeat portal venography after variceal coil embolization shows blood flow through a previously placed transjugular intrahepatic portosystemic shunt with occlusion of the embolized varices (white arrow).
case_images: JCIS-14-16-g004.jpg
case_images: PMC11152535_02_JCIS-14-16-g004.jpg
case_images: F4
case_images: The patient was taken to the interventional radiology suite, where catheter-directed super-selective portal venography showed severe stenosis of the superior mesenteric vein (SMV), resulting in pre-hepatic portal hypertension and giving rise to the culprit varices [Figure 4a]. Subsequent portal venography at the conclusion of the same procedure revealed blood flow through the TIPS with occlusion of the embolized varices [Figure 4b].
case_images: PMC11152535_03
case_images: A 76-year-old woman with congestive heart failure presented with hematochezia. (a) Axial image from computed tomography (CT) angiography shows active bleeding from the ileocolonic branch of the superior mesenteric artery (SMA) in the cecum (white arrow). (b) Coronal reconstruction from the same CT angiography as in (a) depicts the cecal bleeding in a different projection (white arrow). (c) Digital subtraction angiography image from selective arteriography of the SMA (white arrow) shows no active bleeding. (d) Photograph obtained at colonoscopy shows a large ischemic ulcer in the cecum at the site of prior bleeding (white arrow ).
case_images: JCIS-14-16-g005.jpg
case_images: PMC11152535_03_JCIS-14-16-g005.jpg
case_images: F5
case_images: She underwent CT angiography of the abdomen with intravenous contrast that showed active bleeding from the ileocolonic branch of the superior mesenteric artery (SMA) in the cecum [Figure 5a and b]. However, subsequent catheter-directed angiography of the SMA showed no active bleeding [Figure 5c]. The patient then proceeded to colonoscopy that demonstrated a large ischemic ulcer with stigmata of recent, but not active, bleeding in the cecum [Figure 5d].