An Unusual Case of Lumen-Apposing Metal Stent–Related Splenic Capsule Hemorrhage
Bibliographic record
Abstract
A 54-year-old woman with acute pancreatitis 6 months ago presented with abdominal pain and vomiting in the past 2 weeks. A computerized tomography (CT) abdomen showed multiple large fluid collections, largest 9.8 × 11.4 × 8.7 cm in the pancreas tail region (Figure 1A, blue arrow). Using transgastric endoscopic ultrasound, the collection was visualized with some layering of solid material. A cystotome was used to puncture the collection and a 4 cm × 12 mm lumen-apposing metal stent (Hanaro stent, M. I. Tech, Korea) was placed for drainage (Figure 1A, white arrow). Radiographic images of pseudocyst drain and angiography of bleeding site. (A) Computerized tomography (CT) abdomen: blue arrow—multiple large fluid collections, largest 9.8 x 11.4 x 8.7 cm in the pancreas tail region; white arrow—4 cm x 12 mm lumen-apposing metal stent (Hanaro Stent, M. I. Tech, Korea) placed for drainage, (B) CT abdomen with contrast: solid arrow—fluid collection measuring 12 cm with the accumulation of extravasated contrast suggesting hemorrhagic transformation; dashed arrow—large splenic subcapsular/pericapsular hematoma, (C) arteriogram revealing abnormal distal capsular splenic branches with no active extravasation and (D) angiogram of the splenic artery showing proximal embolization with platinum coils. Radiographic images of pseudocyst drain and angiography of bleeding site. (A) Computerized tomography (CT) abdomen: blue arrow—multiple large fluid collections, largest 9.8 x 11.4 x 8.7 cm in the pancreas tail region; white arrow—4 cm x 12 mm lumen-apposing metal stent (Hanaro Stent, M. I. Tech, Korea) placed for drainage, (B) CT abdomen with contrast: solid arrow—fluid collection measuring 12 cm with the accumulation of extravasated contrast suggesting hemorrhagic transformation; dashed arrow—large splenic subcapsular/pericapsular hematoma, (C) arteriogram revealing abnormal distal capsular splenic branches with no active extravasation and (D) angiogram of the splenic artery showing proximal embolization with platinum coils. The next morning her hemoglobin dropped by 31 g/L (from 83 to 52 g/L), but there was no evidence of hematemesis. She was transfused with two units of packed red blood cells and a CT with contrast was done to assess for bleeding. CT showed the fluid collection measuring at 12 cm with accumulation of extravasated contrast suggesting hemorrhagic transformation (Figure 1B, solid arrow) and large splenic subcapsular/pericapsular hematoma (Figure 1B, dashed arrow), displacing the spleen anteroinferiorly and measuring 12 × 17 cm. An arteriogram revealed abnormal distal capsular splenic branches with no active extravasation (Figure 1C). The splenic artery was coiled proximally, which achieved good hemostasis and she recovered well (Figure 1D). A repeat CT 1 week later showed a smaller pseudocyst (8 × 7 × 4 cm) with evolution of the splenic hematoma. Three months later endoscopy was repeated, and the stent was removed without any issues or complications. While several studies have reported adverse events relating to lumen apposing metal stent, this case documents the first splenic capsule hemorrhage associated with lumen apposing metal stent for draining pancreatic fluid collections. L.H. conceived the case presentation. L.H. and D.B. wrote the main text and R.N. prepared the figures. All authors reviewed the report.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.008 | 0.006 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".