Pancreatic tail carcinoma with gastric wall invasion with intragastric rupture of a splenic artery aneurysm while receiving neoadjuvant chemotherapy

Abstract

An 80-year-old man was referred with a resectable 3.5×3cm carcinoma of the pancreatic tail with invasion of the gastric wall and splenic vessels. Staging laparoscopy revealed posterior gastric wall invasion, but no evidence of apparent metastases or disseminated disease. Neoadjuvant therapy with gemcitabine+nab-paclitaxel was given. Five days after administering the third course of chemotherapy, the patient developed hematemesis and hemorrhagic shock. Gastrointestinal hemorrhage due to rupture of the splenic artery pseudoaneurysm at the tumor invasion site in the posterior gastric wall was diagnosed based on abdominal dynamic CT scan. Vital signs stabilized with resuscitation. Transcatheter embolization of the splenic artery was performed and hemostasis achieved. CT scan before discharge revealed lung metastases, representing a contraindication for resection. Although the number of patients receiving preoperative chemotherapy is increasing, patients with adjacent organ involvement should be treated with caution.