Massive bleeding from gastric ulcer-induced splenic artery pseudoaneurysm successfully treated with transcatheter arterial embolization and surgery: a case report.

BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a routine medical emergency. The most common non-variceal cause is peptic ulcer disease, while a rare presentation is peptic ulcer-induced splenic artery pseudoaneurysm (SAP). Primary endoscopic treatment is generally attempted for UGIB; however, it sometimes fails when arterial etiology is present. In such cases, either transcatheter arterial embolization (TAE) or surgery is necessary, but the choice of treatment is controversial. We present a case that illustrates the utility of both approaches in a gastric ulcer-induced SAP. CASE PRESENTATION: A 33-year-old male presented with hemorrhagic shock secondary to UGIB. The source of bleeding was identified as an SAP that was caused by a gastric ulcer. TAE enabled temporary bleeding control despite the patient's poor overall condition and limited blood transfusion capability. However, rebleeding occurred soon after stabilization. Ultimately, we performed proximal gastrectomy and splenic artery ligation, and the patient survived. CONCLUSIONS: SAP is an uncommon occurrence, and angiographic information is important for correctly identifying the source of bleeding. The treatment for SAP bleeding is basically the same as for endoscopically unmanageable non-variceal UGIB, since TAE and surgery each have a different utility, depending on the situation. If surgery is performed, especially SA ligation and gastrectomy, it is important to consider the circulation of the spleen and residual stomach. Using TAE and laparotomy, we managed to save the life of the patient with massive hemorrhage under limited circumstances.

Metachronous colorectal liver metastasis that occurred 10 years after laparoscopic colectomy: a case report.

BACKGROUND: Delayed onset of colorectal liver metastasis (CRLM) > 5 years after primary colorectal surgery is rare. Herein, we report a case of delayed-onset CRLM that occurred 10 years after primary surgery, for which laparoscopic hepatectomy was performed. CASE PRESENTATION: A 68-year-old man was admitted to the hospital. His medical history revealed double colon cancer detected 10 years ago, for which laparoscopic colectomy was performed. The pathological tumor-node-metastasis stages were stages I and II. Thereafter, oral floor cancer occurred 7 years after the primary surgery and was curatively resected. The annual follow-up with positron emission tomography-computed tomography (CT) identified a tumor at segment 7/8 (S7/8) of the liver with an abnormal accumulation of fluorodeoxyglucose. Dynamic CT showed a 23-mm tumor, with ring enhancement in the early phase. Magnetic resonance imaging with gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid demonstrated that the tumor had high intensity in T2 weighted sequences and low intensity in the hepatobiliary phase. With a preoperative diagnosis of intrahepatic cholangiocarcinoma or delayed liver metastasis, laparoscopic S7/8 partial resection was performed. The operative time was 324 min, and the intraoperative bleeding volume was 35 mL. The patient was discharged on day 15 without any postoperative complications. Upon histopathological examination, the final diagnosis was CRLM. The patient has survived for 1 year without any recurrence. CONCLUSIONS: It is important to pay attention to the occurrence of delayed-metachronous CRLM.