Giant splenic artery pseudoaneurysm fistulizing to the colon: A case report and focused literature review

Splenic artery pseudoaneurysm (SAP) is a rare but dangerous visceral arterial lesion, and fistulization into the gastrointestinal tract is an exceptional and life-threatening complication. We report the case of a 73-year-old woman presenting with acute lower gastrointestinal bleeding caused by a giant SAP that had eroded into the splenic flexure of the colon. Proximal embolization using coils and Onyx achieved initial hemostasis. Although the patient was clinically stabilized, she later developed delayed septic and inflammatory complications requiring splenectomy, colonic resection, partial gastrectomy, and removal of the aneurysmal sac. This case, together with our focused review of published SAP fistula cases, highlights that embolization should be considered a temporizing measure when gastrointestinal fistulization is present; early surgical management remains essential to prevent severe infection and multi-organ complications.