Zusammenfassung
Dieser Fallbericht beschreibt den Krankheitsverlauf eines 53-jährigen Patienten, der an einer seit 19 Monaten bestehenden rezidivierenden okkulten gastrointestinalen Blutung leidet. Zahlreiche endoskopische Untersuchungen des oberen und unteren Gastrointestinaltraktes zeigten keine Blutungsquelle. Als der Patient im Rahmen eines Blutungsereignisses synkopierte, wurde an unsere Abteilung transferiert. Eine erneute Gastroskopie zeigte eine große, von der Magen-Hinterwand in das Lumen vorwölbende Raumforderung. Der Tumor imponierte mit weicher Konstistenz sowie einer darüberliegenden intakt wirkenden Magenschleimhaut. Eine endoskopische Ultraschalluntersuchung sowie eine Computertomographie entlarvte den Tumor als teilweise thrombosiertes Milzarterienaneurysma. Mittels Angiographie konnte diese Diagnose bestätigt werden. In weiterer Folge wurde das Milzarterienaneurysma embolisiert. Innerhalb einer nunmehr vier-monatigen Verlaufsperiode sind keine weiteren Blutungsereignisse mehr aufgetreten.
Ein Milzarterienaneurysma stellt zwar eine seltene Ursache für eine okkulte gastrointestinale Blutung dar, sollte jedoch bei jeder frustranen Abklärung einer okkulten gastrointestinalen Blutung berücksichtigt werden.
Summary
A 53-year-old man presented with a 19-month history of gastrointestinal bleeding. Repeated endoscopic investigation of the upper and lower intestine showed no source of bleeding. When the patient collapsed due to massive gastrointestinal hemorrhage he was referred to our center. Gastroscopy showed a large, bulging tumor protruding from the posterior gastric wall. The consistency of this tumor was soft and the overlying mucosa appeared smooth and intact. Endoscopic ultrasound and contrast-enhanced computerized tomography scan identified a partly thrombosized splenic artery aneurysm (SAA). Arteriography of the celiac trunk confirmed the SAA diagnosis; the SAA was subsequently occluded by coils. So far, four months after discharge, the patient is in excellent health and no further episode of gastrointestinal bleeding has occurred.
SAA is a very rare cause of upper gastrointestinal bleeding, but it must be considered when no other common bleeding source can be detected.
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This work was supported by “Verein zur Förderung der Forschung in Gastroenterologie und Hepatologie an der Universität Innsbruck”.
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Koch, R., Graziadei, I., Zoller, H. et al. Posttraumatic splenic artery aneurysm presenting as occult gastrointestinal bleeding. Wien Klin Wochenschr 115, 668–671 (2003). https://doi.org/10.1007/BF03040474
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DOI: https://doi.org/10.1007/BF03040474