Coil Migration after Transarterial Coil Embolization of a Splenic Artery Pseudoaneurysm
A 48-year-old man with a prior history of renal transplantation was admitted to our medical center with 2 weeks of fever, chills and left upper quadrant abdominal pain. His history was significant for end-stage renal disease due to congenital solitary kidney and reflux nephropathy which required cadaveric renal transplantation in 2008. His immunosuppressive regimen included mycophenolate mofetil and tacrolimus. Three months prior to his current presentation he was admitted with Salmonella enteritidis bacteremia. During that hospitalization he was found to have a splenic artery pseudoaneurysm measuring 4.9 × 5.1 × 7.8 cm on abdominal computed tomography. This was suspected to be a mycotic pseudoaneurysm related to the Salmonella infection. After undergoing antibiotic treatment he subsequently underwent interventional radiology-guided coil embolization of the splenic artery pseudoaneurysm without complication.\nAt the time of his current admission, the patient reported 2 weeks of subjective fevers, intermittent chills and abdominal pain. The pain was located in the left upper quadrant, dull in quality, and was not associated with eating. On presentation he was afebrile and had normal vital signs. There were surgical scars from his prior renal transplant surgery. His abdominal exam was notable for mild tenderness in the left upper quadrant with normal bowel sounds. There was no guarding or rebound tenderness. Laboratory tests were notable for a mild leukocytosis and stable renal function (table ). Blood and urine cultures were negative.\nThe patient had an abdominal X-ray revealing a fragment of embolization coil in the right lower quadrant (fig. ). Abdominal/pelvic computed tomography with oral contrast revealed a migrated coil within the right colon (fig. ). The remaining coils appeared to be within the splenic artery. There was no evidence of contrast extravasation or free intraperitoneal air. The patient subsequently underwent diagnostic upper endoscopy. This identified a large mucosal defect in the proximal stomach, with numerous coils extruding into the gastric lumen (fig. ), consistent with a gastrosplenic artery fistula. The patient subsequently underwent exploratory laparotomy with splenectomy, distal pancreatectomy, partial gastrectomy, resection of the splenic artery aneurysm and removal of the splenic aneurysm coils. He had an uneventful recovery and was discharged from hospital 9 days after surgery.