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Historic. A 59-year-old patient, a chronic ethanol user, without any medical history, presents with hematemesis and abdominal pain. Methods. The level of hemoglobin was 8.2 g/dL, without any other biological modification. The emergency upper digestive endoscopy revealed a large clot that almost completely occupied the esophageal and gastric lumen, up to the duodenal angle. Endoscopic re-evaluation at 24 hours: esophagus and stomach with free lumen, gastric body with extrinsic compression on the posterior face towards the greater curvature and intensely edematous mucosa at that level. Abdominal ultrasound revealed multiple calcifications at the level of the pancreatic head and body and at the level of the tail of the pancreas, a cystic formation of approximately 5 cm was visualized, with a pulsed Doppler signal. CEUS:hyperinhancement in the center of the lesion and lack of contrast in the periphery, an aspect that was maintained in the portal and parenchymal phases. The abdominal CT showed a corporeo-caudal pancreatic pseudoaneurysm of the splenic artery with dimensions of 65 mm, with parietal thrombosis with a stratified appearance, affecting about 40% of the lumen, with contrast extravasation, in direct contact with the posterior gastric wall. Results. The suspicion of upper digestive hemorrhage secondary to a fistula between the pseudo-aneurysm of the splenic artery and the stomach was raised, but also the possibility of a wirsungorrhagia, given the direct contact of the lesion with the pancreatic tail. Abdominal angiography with angioplasty was performed, secondary to the extravasation of the contrast substance at the level of the splenic artery with a 3/18 mm Bentley type stent graft, with an optimal result, without extravasation of contrast. Diagnosis. Upper gastrointestinal hemorrhage secondary to a splenic artery pseudoaneurysm. Chronic ethanolic pancreatitis. Conclusions. Bleeding from splenic artery pseudoaneurysm is a rare and often fatal cause of gastrointestinal bleeding The most common causes are pancreatitis and abdominal trauma. In pancreatitis, pancreatic enzymes can cause vascular necrosis and rupture of elastic tissue, leading to pseudoaneurysm formation. Another way can be through pseudocysts (41% of patients with pseudoaneurysms), In this patient's case, the pseudoaneurysm most likely occurred secondary to a pseudocyst that eroded the splenic artery, with intracystic hemorrhage, which led to a localized hemorrhage and not to a hemoperitoneum, and subsequently to the digestive tract, transgastric or through the main pancreatic duct. After stent placement by angiography, the patient had a favorable evolution at ultrasound reevaluation at 1 month, with remission of the lesion. [ABSTRACT FROM AUTHOR]

Aims. An 84-year-old patient with a history of high blood pressure presented to the emergency room with lower abdominal pain and haematochezia. Methods. Clinical:hemodynamically stable. Biological: WBC 32700/microL, Hb=8.1 g/dL, PLT = 321 000/microL, INR=1.23, CRP = 292 mg/L. CTscan: no contrast extravasation in the digestive tract, infrarenal aortic aneurysm (130 mm cranio-caudal), with parietal thrombus plus a retroaortic abscess with stenosis of the inferior vena cava. Vascular surgery consultation: no surgical indication ->admission to the gastroenterology department. Emergency upper GI endoscopy: adherent clot in the fornix, stasis fluid. 60 cm rectosigmoidoscopy: mucosal lesions suggestive of ischemic colitis. Reevaluation after 12 h: WBC = 26 000/microL, hemoglobin = 7.1 g/dL Results. Re-evaluation of the CT-scan: suspicion of an aorto-duodenal fistula. Second upper GI endoscopy: gastric mucosa, bulb and D2 lined with fresh blood. On withdrawal, an infrapapillary lesion suggestive for an aortoenteric fistula. Duodenoscopesecond look:an erosion with a diameter of 10 mm with a deep punctate hole: most likely aortoenteric fistula. The patient was transferred to cardio-vascular surgery: double-layer duodenorrhaphy and aorto-aortic interposition of a silver Dacron prosthesis were done. Conclusion. The particularity of the case was represented by the rare cause of haemorrhage with difficult diagnosis. The approach and treatment required a multidisciplinary team and a good collaboration. The patient was discharged after 17 days with a good general condition. [ABSTRACT FROM AUTHOR]