INTRODUCTION

We present a case of hemorrhage secondary to splenic artery laceration caused by decubitus of a Hot-Axios® stent.

ENDOSCOPY AND CASE REPORT

A 57-year-old woman with a history of distal pancreatectomy for IPMN with low-grade dysplasia. As a complication, she developed a pancreatic fistula with a distal peripancreatic collection. A percutaneous drainage was attempted without success, followed by transgastric drainage using a Hot-Axios® stent at another center. She presented to the emergency department with syncopal episodes. Gastroscopy revealed a normally positioned stent with a coaxial pig-tail and slight oozing of blood around the prosthesis. Laboratory tests showed anemia with hemoglobin dropping to 7.7 g/dL, and CT angiography demonstrated intragastric blood content without active bleeding. A second gastroscopy was performed 24 hours later for stent removal, after which massive hemorrhage occurred, resulting in hypovolemic shock and the need for vasoactive support. An urgent CT angiography revealed splenic artery rupture, and emergent radiological embolization was performed without complications. The patient evolved favorably, later undergoing scheduled splenectomy due to secondary splenic infarctions.

CONCLUSIONS

The use of Hot-Axios® stents has become widespread for the drainage of abdominal collections and is generally considered a safe procedure, although it carries a risk of complications such as bleeding. Most bleeding events are associated with the development of arterial pseudoaneurysms, and delayed stent removal appears to be a potential risk factor. In our case, bleeding resulted from splenic artery laceration due to contact with the edge of the stent. The coaxial placement of a pig-tail stent may reduce this risk, although current evidence is insufficient. In conclusion, early detection and management of this complication are essential due to its severity.