A Rare Cause of Delayed Bleeding Post-Laparoscopic Sleeve Gastrectomy: Splenic Artery Pseudoaneurysm

Background: Laparoscopic sleeve gastrectomy (LSG) is a relatively new procedure in bariatric surgery that becomes very popular. Bleeding is an uncommon complication of this surgery. However, failure to manage it appropriately can result in significantly increased morbidity and mortality.

Case: This is a 55-year-old man who underwent LSG 4 years ago and had an uncomplicated postoperative course presented with new onset abdominal pain, syncope, and hypotension with no history of GI bleeding or recent trauma. Abdominal CT angiography revealed intraperitoneal rupture of a splenic artery pseudoaneurysm (SAP) that was noted in close proximity to gastric sleeve surgical clips. This decision was to proceed with angiogram of the splenic artery that showed mid-third narrow neck SAP, then using microcatheter, multiple embolization microcoils and interlock coils were deployed to tightly pack the aneurysmal sac. Postprocedure angiogram of the splenic artery showed total occlusion of the SAP. Patient clinical condition improved and was discharged with uneventful postprocedural course.

Discussion: Late-onset SAP is a rare complication of LSG and needs high index of suspension and awareness of CT findings. In hemodynamically stable patients, radiologic interventional approaches play a vital role as both diagnostic and therapeutic tools with markedly lower mortality compared with open surgery.

Publication History

Article published online:
09 February 2023