Abstract
This report details a rare case of intraperitoneal bleeding from a failed puncture site during percutaneous trans-splenic portal vein access. A man in his 60s, who had undergone surgery for gallbladder cancer, presented with recurrent melena. Sclerotherapy for hepatopetal ectopic varices in the elevated jejunum loop was attempted using a percutaneous trans-splenic approach due to extrahepatic portal vein obstruction, which led to intraperitoneal bleeding. Despite initial splenic artery embolization, persistent bleeding required embolization of an intra-splenic vein branch. Although percutaneous trans-splenic portal vein access is generally safe, complications such as intraperitoneal bleeding can occur. Previous studies have highlighted the need for splenic artery embolization. However, this case emphasizes the importance of recognizing splenic venous bleeding as a potential complication and underscores the need for comprehensive management strategies.