Splenic artery pseudoaneurysm presenting as massive haematemesis during endoscopic management of post-sleeve gastrectomy leak: a case report.

Visceral artery pseudoaneurysm is a rare, potentially fatal complication of post-sleeve gastrectomy (LSG) staple-line leak. We report a 36-year-old woman who presented with a proximal staple-line leak, managed with laparoscopic washout and endoscopic stenting. During apparent clinical improvement, she experienced sentinel haemorrhage on postoperative Day 30, initially attributed to stent-related mucosal trauma. Catastrophic haemorrhage ensued 2.5 hours later. Endoscopy revealed a clot-filled stent without a mucosal source; computed tomography angiography (CTA) identified a 20 × 18 × 13 mm splenic artery pseudoaneurysm within the perigastric collection. Proximal coil angioembolization achieved complete exclusion without splenic infarction. The patient made a full recovery and was discharged home on postoperative Day 42. This case illustrates a potentially fatal vascular complication arising during active leak management. A splenic artery pseudoaneurysm must be actively sought in any upper gastrointestinal bleeding during post-LSG leak management, and CTA must exclude a vascular source before attributing bleeding to stent-related mucosal trauma.