This case report demonstrates a, yet unreported, very late adverse event of splenic artery coil-embolization for splenic trauma. Gastrosplenic collaterals developed in the gastric wall over 30 years and eroded into the gastric lumen with subsequent upper gastrointestinal bleeding. However, it is unclear if this late bleeding complication after segmental splenic artery coil embolization may also occur after main splenic artery occlusion, as nowadays most often performed to manage splenic trauma (Quencer & Smith, 2019). These submucosal collaterals may be misinterpreted as varices on upper endoscopy (Mnatzakanian et al., 2008) and endoscopic injection of sclerosant agents might be a suboptimal treatment with potential non-target migration of the injected material. Enlarged gastrosplenic collaterals have been described in patients with congenital absence of the splenic artery (Spriggs, 1984) and in patients with main splenic artery occlusion related to different etiologies, including blunt abdominal trauma (Baron et al., 2000), splenic artery surgery, including aneurysmectomy and main splenic artery ligation after liver transplantation (Worthley et al., 2003; Keramidas et al., 1984). Irrespective of the underlying etiology of absence or occlusion of the main splenic artery, gastrosplenic collaterals may develop in the gastric wall and erode in the gastric lumen, resulting in severe intestinal bleeding. Abdominal CT study revealed these hypertrophied collaterals in the gastric wall and prompted referral to interventional radiology for embolization.
Embolization was performed with glue, occluding the whole cluster of gastric wall collaterals, as confirmed by follow-up CT and upper endoscopy, showing a part of the cast protruding through the gastric mucosa into the gastric lumen. The strand of glue cast, clearly visible on follow-up endoscopy, most probably completely occluded the index bleeding point. In addition, despite a substantial amount of glue injected and gastrosplenic collaterals embolized, no clinical, radiologic or endoscopic signs of gastric ischemia could be identified.
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