{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T21:46:53Z","timestamp":1768772813227,"version":"3.49.0"},"reference-count":26,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T00:00:00Z","timestamp":1741046400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Despite advancements in prevention and treatment, peptic ulcer disease (PUD) remains a public health burden, with potentially high mortality rates when not managed properly. Recent studies indicate bleeding as the most prevalent complication, followed by perforation or penetration into adjacent organs and pyloric obstruction. In rare cases, posterior wall or greater curvature ulcers of the stomach can penetrate, leading to splenic artery pseudoaneurysms. With nonspecific symptoms and low incidence, it is highly important that these entities are not overlooked in the diagnosis of patients with upper gastrointestinal bleeding. Case Report: We present the case of a 44-year-old patient presenting for upper abdominal pain and haematemesis while being haemodynamically stable. Emergency ultrasound described a dysmorphic spleen, with a transonic image with a Doppler signal in the splenic hilum. Upper gastrointestinal tract endoscopy detected a blood-filled stomach, without the possibility of identifying the bleeding source. The CT scan revealed active bleeding with peri splenic haematoma. Intraoperatively, a posterior gastric wall penetration into the spleen was identified, and an atypical gastric resection and caudal splenopancreatectomy were performed. The postoperative course was marked by the identification of a staple line leak in the upper pole of the stomach, which was treated conservatively, with a favourable outcome, and the patient was discharged after two weeks. Conclusions: Upper gastrointestinal tract haemorrhage needs fast intervention and suitable management. The multidisciplinary team plays a key role in identifying and treating rare causes such as penetration into the splenic hilum.<\/jats:p>","DOI":"10.3390\/diagnostics15050617","type":"journal-article","created":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T05:41:51Z","timestamp":1741066911000},"page":"617","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Rare Encounter: Gastric Ulcer Penetration into the Splenic Hilum Presenting with Upper Gastrointestinal Bleeding and a Massive Splenic Haematoma\u2014Case Report and Literature Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9016-5690","authenticated-orcid":false,"given":"Ioana-Irina","family":"Rezu\u0219","sequence":"first","affiliation":[{"name":"Department of Radiology, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Ia\u0219i, Romania"},{"name":"Radiology Clinic, \u201cSt. Spiridon\u201d County Clinical Emergency Hospital, 700111 Ia\u0219i, Romania"},{"name":"Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6226-2196","authenticated-orcid":false,"given":"Vasile-Claudiu","family":"Mihai","sequence":"additional","affiliation":[{"name":"Department of Radiology, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Ia\u0219i, Romania"},{"name":"Radiology Clinic, \u201cSt. Spiridon\u201d County Clinical Emergency Hospital, 700111 Ia\u0219i, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2727-9913","authenticated-orcid":false,"given":"Diana Elena","family":"Floria","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary"},{"name":"1st Internal Medical Department, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Ia\u0219i, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d County Clinical Emergency Hospital, 700111 Ia\u0219i, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3204-0878","authenticated-orcid":false,"given":"Andrei","family":"Olteanu","sequence":"additional","affiliation":[{"name":"1st Internal Medical Department, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Ia\u0219i, Romania"},{"name":"Institute of Gastroenterology and Hepatology, \u201cSt. Spiridon\u201d County Clinical Emergency Hospital, 700111 Ia\u0219i, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vlad Ionut","family":"Vlasceanu","sequence":"additional","affiliation":[{"name":"Department of Surgery I, \u201dGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Ia\u0219i, Romania"},{"name":"Department of Surgery, \u201cSt. Spiridon\u201d County Clinical Emergency Hospital, 700111 Ia\u0219i, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Radu Petru","family":"Soroceanu","sequence":"additional","affiliation":[{"name":"Department of Surgery I, \u201dGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Ia\u0219i, Romania"},{"name":"Department of Surgery, \u201cSt. Spiridon\u201d County Clinical Emergency Hospital, 700111 Ia\u0219i, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5730-1662","authenticated-orcid":false,"given":"Alin Constantin","family":"Pinzariu","sequence":"additional","affiliation":[{"name":"Department of Morpho-Functional Sciences II, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Ia\u0219i, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9530-7886","authenticated-orcid":false,"given":"Brigitta","family":"Teutsch","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary"},{"name":"Department of Radiology, Medical Imaging Centre, Semmelweis University, 1082 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergiu","family":"Tudose-Timofeiov","sequence":"additional","affiliation":[{"name":"Department of Surgery I, \u201dGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Ia\u0219i, Romania"},{"name":"Department of Surgery, \u201cSt. Spiridon\u201d County Clinical Emergency Hospital, 700111 Ia\u0219i, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/S0140-6736(16)32404-7","article-title":"Peptic Ulcer Disease","volume":"390","author":"Lanas","year":"2017","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1832","DOI":"10.1001\/jama.2024.19094","article-title":"Peptic Ulcer Disease: A Review","volume":"332","author":"Vakil","year":"2024","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1159\/000323958","article-title":"Systematic Review of the Epidemiology of Complicated Peptic Ulcer Disease: Incidence, Recurrence, Risk Factors and Mortality","volume":"84","author":"Lau","year":"2011","journal-title":"Digestion"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1016\/S0140-6736(15)00276-7","article-title":"Perforated Peptic Ulcer","volume":"386","author":"Thorsen","year":"2015","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"5302","DOI":"10.3748\/wjg.v26.i35.5302","article-title":"Epidemiology of Perforating Peptic Ulcer: A Population-Based Retrospective Study over 40 Years","volume":"26","author":"Dadfar","year":"2020","journal-title":"World J. Gastroenterol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s13017-019-0283-9","article-title":"Perforated and Bleeding Peptic Ulcer: WSES Guidelines","volume":"15","author":"Tarasconi","year":"2020","journal-title":"World J. Emerg. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e11589","DOI":"10.1097\/MD.0000000000011589","article-title":"Splenic Artery Pseudoaneurysm with Splenic Infarction Induced by a Benign Gastric Ulcer: A Case Report","volume":"97","author":"Cho","year":"2018","journal-title":"Medicine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"499","DOI":"10.12659\/PJR.895126","article-title":"Large Gastric Perforation Sealed by Splenic Lysis: Emphasis on Indirect Signs\u2014A Rare Case Report","volume":"80","author":"Garg","year":"2015","journal-title":"Pol. J. Radiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"53","DOI":"10.21614\/sgo-402","article-title":"Posterior Perforation by Peptic Ulcer. Our 12-Year Experience of 6 Cases","volume":"27","author":"Matei","year":"2022","journal-title":"SGO"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.surg.2003.11.001","article-title":"Posterior Perforation of Peptic Ulcers: Presentation and Outcome of an Uncommon Surgical Emergency","volume":"135","author":"Wong","year":"2004","journal-title":"Surgery"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Corvino, F., Giurazza, F., Ierardi, A.M., Lucatelli, P., Basile, A., Corvino, A., and Niola, R. (2022). Splenic Artery Pseudoaneurysms: The Role of Ce-CT for Diagnosis and Treatment Planning. Diagnostics, 12.","DOI":"10.3390\/diagnostics12041012"},{"key":"ref_12","first-page":"501937","article-title":"Splenic Artery Pseudoaneurysm Presenting as Massive Hematemesis: A Diagnostic Dilemma","volume":"2014","author":"Varshney","year":"2014","journal-title":"Case Rep. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1016\/S0741-5214(03)00710-9","article-title":"Clinical Features and Management of Splenic Artery Pseudoaneurysm: Case Series and Cumulative Review of Literature","volume":"38","author":"Tessier","year":"2003","journal-title":"J. Vasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e05561","DOI":"10.1002\/ccr3.5561","article-title":"Life-Threatening Gastrointestinal Bleeding from Splenic Artery Pseudoaneurysm Due to Gastric Ulcer Penetration Treated by Surgical Hemostasis with Resuscitative Endovascular Balloon Occlusion of the Aorta: A Case Report","volume":"10","author":"Nakata","year":"2022","journal-title":"Clin. Case Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"384","DOI":"10.12659\/PJR.894465","article-title":"Massive Upper Gastrointestinal Bleeding from a Splenic Artery Pseudoaneurysm Caused by a Penetrating Gastric Ulcer: Case Report and Review of Literature","volume":"80","author":"Sawicki","year":"2015","journal-title":"Pol. J. Radiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2369","DOI":"10.3390\/tomography8050198","article-title":"The Role of CT-Angiography in the Acute Gastrointestinal Bleeding: A Pictorial Essay of Active and Obscure Findings","volume":"8","author":"Iacobellis","year":"2022","journal-title":"Tomography"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"E272","DOI":"10.1503\/cjs.009519","article-title":"Visceral Artery Pseudoaneurysm in Necrotizing Pancreatitis: Incidence and Outcomes","volume":"63","author":"Maatman","year":"2020","journal-title":"Can. J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1097\/MEG.0000000000000951","article-title":"Outcomes of Patients Hospitalized with Peptic Ulcer Disease Diagnosed in Acute Upper Endoscopy","volume":"29","author":"Malmi","year":"2017","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"423","DOI":"10.21614\/chirurgia.115.4.423","article-title":"Post-Gastrectomy Complications\u2014An Overview","volume":"115","author":"Samrat","year":"2020","journal-title":"Chirurgia"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Savin, M.L., Mihai, F., Gheorghe, L., Lupascu Ursulescu, C., Negru, D., Trofin, A.M., Zabara, M., Nutu, V., Cadar, R., and Blaj, M. (2021). Proposal of a Preoperative CT-Based Score to Predict the Risk of Clinically Relevant Pancreatic Fistula after Cephalic Pancreatoduodenectomy. Medicina, 57.","DOI":"10.3390\/medicina57070650"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.jviscsurg.2016.04.013","article-title":"Medical Complications Following Splenectomy","volume":"153","author":"Barbier","year":"2016","journal-title":"J. Visc. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Venturini, M., Piacentino, F., Coppola, A., Bettoni, V., Macchi, E., De Marchi, G., Curti, M., Ossola, C., Marra, P., and Palmisano, A. (2021). Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives. J. Clin. Med., 10.","DOI":"10.3390\/jcm10112520"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Timpau, A.-S., Miftode, R.-S., Costache, I.-I., Petris, A.O., Miftode, I.-L., Gheorghe, L., Timpau, R., Miftode, I.D., Prepeliuc, C.S., and Coman, I. (2023). An Overview of the Impact of Bacterial Infections and the Associated Mortality Predictors in Patients with COVID-19 Admitted to a Tertiary Center from Eastern Europe. Antibiotics, 12.","DOI":"10.3390\/antibiotics12010144"},{"key":"ref_24","first-page":"350","article-title":"Penetration of Gastric Ulcer into the Splenic Artery: A Rare Complication","volume":"2","author":"Pasumarthy","year":"2009","journal-title":"Gastroenterol. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1186\/s40792-022-01552-0","article-title":"Massive Bleeding from Gastric Ulcer-Induced Splenic Artery Pseudoaneurysm Successfully Treated with Transcatheter Arterial Embolization and Surgery: A Case Report","volume":"8","author":"Shidahara","year":"2022","journal-title":"Surg. Case Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"rju102","DOI":"10.1093\/jscr\/rju102","article-title":"A Benign Gastric Ulcer Eroding into a Splenic Artery Pseudoaneurysm Presenting as a Massive Upper Gastrointestinal Bleed","volume":"2014","author":"Syed","year":"2014","journal-title":"J. Surg. Case Rep."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/5\/617\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:46:51Z","timestamp":1760028411000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/5\/617"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,4]]},"references-count":26,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["diagnostics15050617"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15050617","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,4]]}}}