A Rare Cause of Life-Threatening Rectal Bleeding in Acute Pancreatitis

A 71-year-old man presented with severe abdominal pain and jaundice.Multimodal imaging diagnosed necrotizing pancreatitis secondary to choledocholithiasis, complicated by acute peripancreatic collections and nonocclusive left portal vein thrombosis.Therapeutic anticoagulation with low-molecular-weight heparin was commenced for the portal vein thrombosis.Six days later, the patient developed hemorrhagic shock due to large-volume frank rectal bleeding, requiring massive blood transfusion and vasopressor support.Computed tomographic angiography demonstrated a pseudoaneurysm arising from a distal branch of the splenic artery with a surrounding hematoma and active contrast extravasation at the splenic flexure into the descending colon (Figure 1).Digital subtraction angiography of the splenic artery confirmed the pseudoaneurysm arising from a distal pancreatic branch with a communicating omental branch (Figure 2).Hemostasis was achieved with endovascular cyanoacrylate-based glue embolization of both vessels (Figure 2).The patient stabilized with no further episodes of rectal bleeding at 6-month follow-up.Pseudoaneurysms are at high risk of rupture and may present with hemodynamic collapse.1 Timely recognition and urgent intervention are therefore essential.Endovascular embolization with coils, cyanoacrylate glue, or both is performed according to vessel anatomy. 2 Gastrointestinal hemorrhage in pancreatitis should prompt evaluation of splenic artery pseudoaneurysm as a rare but life-threatening source of bleeding.