A Case of Spontaneous Stomach Rupture Associated with Intragastric Penetration of a Splenic Artery Aneurysm

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  • 脾動脈瘤胃内穿破による特発性胃破裂の1救命例

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Abstract

<p>A 75-year-old male was transported to our hospital because of hematemesis. Computed tomography (CT) showed an aneurysm in the distal splenic artery perforating into the stomach. We performed transcatheter arterial embolization of the splenic artery aneurysm and hemostasis was obtained. We performed an abdominal paracentesis on the next day and found high levels of alkaline phosphatase and amylase in the fluid collection suggesting a stomach rupture. The subsequent CT examination on ICU day 3 showed the rupture of the stomach, and we performed an emergency laparotomy. We found an approximately 10cm laceration in the anterior wall of the gastric body on the side of the lesser curvature presumably caused by the perforation of the splenic artery aneurysm. We made a primary closure of the laceration with an Albert-Lembert suture. The patient, who was under respirator management, was extubated on ICU day 5 and his oral ingestion began on ICU day 11. He was discharged on hospitalization day 60 with a good postoperative course. Perforation with a splenic artery aneurysm and rupture of the stomach are both critical injuries requiring prompt initial management for bleeding and less invasive surgical intervention to get a good outcome.</p>

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