Endoscopic ultrasound related partial splenic artery embolization: A gifted outcome

Excerpt

A 20-year-old female, a case of extrahepatic portal venous obstruction (EHPVO) presented with recurrent upper gastrointestinal (GI) bleeding for 3 years, easy fatigability, and epistaxis for 6 months. Examination revealed pallor and splenomegaly. Hemogram showed pancytopenia. She was planned for partial splenorenal shunt and splenectomy because of refractory variceal bleeding and symptomatic hypersplenism. Pre-operative computerized tomography (CT) of abdomen with angiography revealed incidental splenic artery pseudoaneurysm near pancreatic tail (Fig. 1A, B). As pre-operative management of pseudoaneurysm, endoscopic ultrasound (EUS)-guided coil embolization (Fig. 1C) was performed wherein two coils were placed into the pseudoaneurysm. Post-embolization, patient developed left hypochondrial pain, fever, and ascites. Distal migration of one of the coils into splenic artery branches was noted on repeat CT scan which also revealed a large splenic infarct (Fig. 2). With conservative management, she became asymptomatic on day 3, and her pancytopenia started to resolve from day 4 of the EUS.

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