Massive Haematochezia due to Splenic Artery Bleeding into the Colon: Unusual Manifestation of Advanced Pancreatic Cancer

Figure 1

(a) Coronal reformatted contrast-enhanced CT demonstrates a large necrotic tumor in the pancreatic tail with suspicion of a fistula extending to the left colic angle (white arrow). (b) Digital subtraction angiography of the splenic artery shows caliber irregularities of the proximal and middle thirds of the vessel and a 15 mm diameter pseudoaneurysm (black arrow) of the middle third of the artery, without contrast extravasation; in the normal segments, the splenic artery measures 4–5 mm of diameter. Coronal reformatted CT with maximal intensity projection before (c) and after (d) positive contrast injection through the drainage catheter (asterisk) placed in the necrotic pancreatic mass reveals a pancreatico-colic fistula (black arrowhead) responsible for a concomitant opacification of the left colon. Images were acquired after endovascular embolization with coils (white arrowhead).

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