Successful embolisation of a life threatening bleeding splenic metastasis in a patient with gestational choriocarcinoma

Introduction: Gestational choriocarcinoma can present with widespread haemorrhagic metastatic disease that may bleed heavily. We present a case of choriocarcinoma with life threatening bleeding from a splenic metastasis which was successfully managed with splenic artery embolization. Case presentation: A 28 year old female presented 9 weeks after the term delivery of a healthy baby with severe abdominal pain, shortness of breath and headaches. A CT scan indicated the presence of haemoperitoneum and metastases in the liver, spleen, kidney and brain. The serum hCG level at presentation was elevated and reported as being greater than 225,000IU/L, the upper limit of the assay used. An emergency laparotomy controlled the bleeding from a large liver metastasis and the pathology confirmed the diagnosis of choriocarcinoma. On transfer to Charing Cross Hospital, combination chemotherapy was started urgently with a prompt symptomatic improvement and rapid fall in the hCG level. However the splenic lesion continued to bleed and threatened to rupture the grossly expanded splenic capsule. A selective splenic artery embolisation of the bleeding arterial pseudoaneurysm was performed with excellent haemostatic control. Following the procedure, combination chemotherapy was continued for a total of 5 months treatment and now 3 years on from treatment completion the patient remains well and is almost certainly cured. Conclusion: Patients with choriocarcinoma can present with significant haemorrhage which can be require expert multidisciplinary team management. Selective arterial embolisation can be life saving and should be considered in other similar cases. Correspondence to: Philip Savage PhD FRCP, Consultant in Medical Oncology, Imperial Hospitals NHS Trust Charing Cross Hospital, London W6 8RF, UK, Tel 0203-311-1419; Fax 0203-313-5577; E-mail: savage13561@msn.com