{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,20]],"date-time":"2025-12-20T06:31:27Z","timestamp":1766212287210,"version":"3.48.0"},"reference-count":9,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T00:00:00Z","timestamp":1766016000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016646","name":"HCA Healthcare","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100016646","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Splenic artery pseudoaneurysm (SAP) is a rare but life-threatening complication of chronic pancreatitis. Although endovascular embolization achieves high technical success, recurrence and delayed rupture may occur, particularly in patients with ongoing pancreatic inflammation or alcohol use disorder (AUD). Case Presentation: A 47-year-old woman with alcohol-associated chronic pancreatitis presented with hematochezia, melena, and syncope. CT angiography revealed a 3.6 cm SAP adjacent to a 4.2 cm pancreatic head pseudocyst, and she underwent successful coil embolization. Despite initial stability, she relapsed into heavy alcohol use, experienced recurrent pancreatitis flares, and developed progressive multisystem comorbidities. Surveillance imaging up to three months post-embolization showed pseudocyst fluctuations without early recanalization, but long-term follow-up lapsed. Eight months after embolization, she presented in hemorrhagic shock from recurrent SAP rupture and died despite massive transfusion and emergent splenic artery ligation. Conclusions: Fatal SAP rupture may occur months after technically successful embolization. Sentinel bleeding, AUD relapse, and progressive systemic decline are critical warning signs. Structured post-embolization imaging and multidisciplinary management are essential to improve long-term outcomes.<\/jats:p>","DOI":"10.3390\/reports8040269","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T09:15:21Z","timestamp":1766049321000},"page":"269","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fatal Recurrent Splenic Artery Pseudoaneurysm Rupture Despite Prior Successful Embolization in Alcohol-Associated Chronic Pancreatitis: A Case Report"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7266-0364","authenticated-orcid":false,"given":"Nawras","family":"Ibrahim","sequence":"first","affiliation":[{"name":"HCA Houston Healthcare Clear Lake, University of Houston College of Medicine, Houston, TX 77598, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"St\u00e9phanie","family":"Ammari","sequence":"additional","affiliation":[{"name":"HCA Houston Healthcare Clear Lake, University of Houston College of Medicine, Houston, TX 77598, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faiza","family":"Malik","sequence":"additional","affiliation":[{"name":"HCA Houston Healthcare Clear Lake, University of Houston College of Medicine, Houston, TX 77598, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,18]]},"reference":[{"key":"ref_1","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","volume":"38","author":"Tessier","year":"2003","journal-title":"J. Vasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1002\/bjs.1800780910","article-title":"Bleeding pseudocysts and pseudoaneurysms in chronic pancreatitis","volume":"78","author":"Parc","year":"1991","journal-title":"J. Br. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Hsu, J.T., Yeh, C.N., Hung, C.F., Chen, H.M., Hwang, T.L., Jan, Y.Y., and Chen, M.F. (2006). Management and outcome of bleeding pseudoaneurysm in chronic pancreatitis. BMC Gastroenterol., 6.","DOI":"10.1186\/1471-230X-6-3"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.pan.2020.11.017","article-title":"Efficacy of endovascular embolization of arterial pseudoaneurysms in pancreatitis: A systematic review and meta-analysis","volume":"21","author":"Sagar","year":"2021","journal-title":"Pancreatology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.jvir.2021.08.004","article-title":"Immediate and long-term outcomes of percutaneous embolization of pancreatitis-related pseudoaneurysms","volume":"32","author":"Madhusudhan","year":"2021","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3S","DOI":"10.1016\/j.jvs.2020.01.039","article-title":"The Society for Vascular Surgery clinical practice guidelines on the management of visceral aneurysms","volume":"72","author":"Chaer","year":"2020","journal-title":"J. Vasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Corvino, F., Berritto, D., Marra, P., Giurazza, F., Lerardi, A.M., Lucatelli, P., Basile, A., Corvino, A., and Niola, R. (2022). Splenic artery pseudoaneurysms: The role of contrast-enhanced CT for detection and management. Diagnostics, 12.","DOI":"10.3390\/diagnostics12041012"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1177\/0284185116648502","article-title":"Long-term clinical and radiological outcome of endovascular embolization of pancreatitis-related pseudoaneurysms","volume":"58","author":"Laleman","year":"2017","journal-title":"Acta Radiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1186\/s13256-024-04581-5","article-title":"Splenic artery pseudoaneurysm; a cause or consequence: A case report","volume":"18","author":"Abbas","year":"2024","journal-title":"J. Med. Case Rep."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/4\/269\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,20]],"date-time":"2025-12-20T05:19:11Z","timestamp":1766207951000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/4\/269"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,18]]},"references-count":9,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["reports8040269"],"URL":"https:\/\/doi.org\/10.3390\/reports8040269","relation":{},"ISSN":["2571-841X"],"issn-type":[{"type":"electronic","value":"2571-841X"}],"subject":[],"published":{"date-parts":[[2025,12,18]]}}}