Fig 2 - available via license: CC BY-NC
Content may be subject to copyright.
Contrast-enhanced CT scan showing a pancreatic pseudocyst with a maximum diameter of 70 mm (arrows). Inside the pseudocyst is a pseudoaneurysm originating from the splenic artery with a maximum diameter of 41 mm (asterisk).
Source publication
The formation of pancreatic pseudocysts and (pseudo-)aneurysms of intestinal vessels are rare but life-threatening complications in acute and chronic pancreatitis. Here we report the rare case of a patient suffering from chronic pancreatitis with an arterial pseudoaneurysm within a pancreatic pseudocyst and present its successful therapeutic manage...
Context in source publication
Context 1
... patient was transferred to our tertiary care center for further evaluation and therapy. A contrast-enhanced CT scan at admission (Fig. 2) showed multiple calcifications in the head and body of the pancreas, as well as an irregularly widened pancreatic duct as signs of a chronic pancreatitis. There were no signs of an acute pancreatitis. The known pseudocyst showed a further increase in maximum diameter to 70 mm (arrows). Inside the pseudocyst, a pseudoaneurysm ...
Similar publications
Giant superior mesenteric artery (SMA) pseudoaneurysms are a very rare clinical entity and follow a spectrum of their initial clinical manifestation. Due to the inherent increased mortality risk, in the face of rupture, urgent treatment is warranted. In this case report, we report the case of a 51-year-old patient with chronic pancreatitis complica...
Acute and chronic pancreatitis are among the most common diseases of the gastrointestinal tract. Most cases of acute pancreatitis are mild to moderate, but 15-20% of patients develop severe forms of pancreatitis that require surgery in 10.5% of cases. One of the complications of acute pancreatitis is the formation of pseudocysts. In rare cases, pse...
Splenic artery pseudoaneurysm is the most common of all the visceral artery pseudoaneurysms. Presentation is often variable and the condition demands immediate diagnosis and management because pseudoaneurysm rupture increases morbidity and mortality. It is associated with pancreatitis and other conditions like abdominal trauma, chronic pancreatitis...
Hemorrhagic pseudocysts with pseudoaneurysms are a rare and fatal complication of chronic pancreatitis due to the erosion of pancreatic to peripancreatic arteries. The timing of the rupture cannot be accurately predicted, but prompt diagnosis and management are essential to prevent further bleeding. We describe the case of a 68-year-old man who pre...
Vascular involvement of pancreatic pseudocyst is a rare complication that can potentially result in a fatal outcome. If there is vascular involvement, the splenic artery is most often involved; its rupture and massive bleeding into the peritoneal cavity or retroperitoneal space can lead to hypovolemic shock. We report on a 66-year-old-male patient,...
Citations
... The presence of air bubbles helps confirm an abscess diagnosis, but the lack thereof does not rule it out [26,27]. Doppler US should be used to examine the fluid collections in the vicinity of vessels or inflamed pancreas to rule out pseudoaneurysms [28,29]. ...
Image-guided percutaneous abscess drainage (IPAD) is an effective, minimally invasive technique to manage infected abdominal fluid collections in children. It is the treatment of choice in cases where surgery is not immediately required due to another coexisting indication. The skills and equipment needed for this procedure are widely available. IPAD is typically guided by ultrasound, fluoroscopy, computed tomography, or a combination thereof. Abscesses in hard-to-reach locations can be drained by intercostal, transhepatic, transgluteal, transrectal, or transvaginal approaches. Pediatric IPAD has a success rate of over 80% and a low complication rate.
... Doppler ultrasound (US) can establish the diagnosis of pseudoaneurysm by demonstrating a classic "yin-yang sign" and "to-and-fro" spectral waveform. 3,7,9 However, US is operator dependent and has low sensitivity in detection of the pancreatic pseudoaneurysm due to its deep retroperitoneal location. 10 CT angiography has higher sensitivity and specificity in diagnosis of pancreatic pseudoaneurysm. ...
Bleeding pseudoaneurysm is a rare but yet potentially lethal complication in a patient with chronic pancreatitis. It also poses a diagnostic challenge among the radiologists and the attending physicians. The mortality rate can be as high as 50% depending on the clinical status, patient hemodynamics, site, and characteristics of the bleeding pseudoaneurysm. Multidisciplinary team approach is essential to deliver the optimum treatment strategy to each individual patient. In this article, we present a case of chronic pancreatitis that presents with acute epigastric pain caused by ruptured pancreaticoduodenal artery pseudoaneurysm in an unusual location. This patient was successfully treated with transcatheter coil embolization.
... Существуют ситуации, при которых ПК может оказывать внешнее давление на прилежащие артериальные сосуды, что в сочетании с воздействием на стенку сосуда ферментов ПЖ, может привести к образованию псевдоаневризм и последующим острым артериальным кровотечениям. В данной ситуации может развиться клинически значимое внутрибрюшное кровотечение или кровоизлияние в просвет кисты с последующим ее разрывом или без него [37,38]. Наиболее частыми местами артериального кровотечения являются: селезеночная артерия, затем следуют гастродуоденальная или панкреатодуоденальная артерии [39]. ...
The therapeutic tactics for pancreatic pseudocysts have changed dramatically over the past decade. Currently, due to the rapid development of minimally invasive technologies, the frequency of their use in the treatment of patients with pseudocysts has become widespread, displacing traditional methods of surgical treatment. Nevertheless, surgical treatment of a pseudocyst is justified when other methods of treatment have been ineffective, namely in the case of recurrence of the pseudocyst, with suspected cystic neoplasia of the pancreas, the presence of stenosis of the common bile duct or duodenum, as well as with complicated cysts. The purpose of this article is a literature review of methods and approaches to the surgical treatment of pancreatic pseudocysts, as well as the treatment of vascular complications in this pathology.
... In the event of significant bleeding, ruptured PA is safely and successfully managed by angiography followed by transcatheter arterial emboli zation. 11 The success rate of transcatheter arterial emboliza tion in recent studies is 95% to 97%. 10,12 Even patients in critical condition can tolerate embolization better than sur gery. ...
Pancreatic pseudocyst is a common complication of pancreatitis. Pseudocysts may require decompression when they become painful, infected, or start compressing surrounding organs. Decompression is achieved by endoscopic cystogastrostomy. Recently, the use of lumen-apposing metal stent (LAMS) for cystogastrostomy has gained popularity due to ease of use and high technical success. LAMS has a wider lumen, which allows for direct endoscopic necrosectomy in the cases of walled-off necrosis. Our patient is a 30-year-old male who presented with massive hematemesis and dizziness. He had a history of chronic alcohol-induced pancreatitis. Three weeks before the presentation, he underwent a cystogastrostomy with LAMS placement to treat a 10-cm walled-off necrosis. Urgent computed tomography (CT) scan did not reveal any acute finding suggestive of bleeding. Esophagogastroduodenoscopy showed blood protruding from the LAMS with a large clot formation. Attempts to stop bleeding were unsuccessful. He underwent CT angiography of the abdomen. CT angiography showed a bleeding pseudoaneurysm (PA) believed to be a complication of the LAMS. Subsequently, multiple coils were placed in the splenic artery near the PA. The patient continued to improve without a further drop in hemoglobin and was eventually discharged. PA formation and subsequent rupture is a rare delayed complication of LAMS. It may lead to massive gastrointestinal bleeding with a high mortality rate. Diagnostic delays have resulted in increased mortality by 60%. In this article, we present a case of massive gastrointestinal bleeding due to a ruptured splenic artery PA presenting as a delayed complication of LAMS.
Rationale
This case report discusses the CT-guided percutaneous drainage of a pancreatic pseudocyst accompanied by a pseudoaneurysm. Pancreatic pseudocysts can erode the peripancreatic artery and produce pseudoaneurysms. This is rare, but it can be life-threatening.
Patient concerns
The case presented involves a 58-year-old female who was diagnosed with pancreatic cancer and underwent surgical treatment. She presented with hematochezia, dizziness, and hypodynamic findings with no obvious cause. Imaging revealed a pancreatic pseudocyst and small arterial aneurysms. To reduce the risk of aneurysm rupture, the patient underwent transcatheter arterial coil embolization. Three days later, CT-guided catheter drainage was performed to reduce the erosion of the arterial wall caused by pancreatic fluid.
Diagnoses
The contrast-enhanced-CT imaging showed a round, slightly high-density lesion in the cyst, suggesting the presence of a pseudoaneurysm.
Interventions
The patient was sent for another transcatheter arterial embolization with coils and n-butyl-2-cyanoacrylate.
Outcomes
After receiving the transcatheter arterial embolization, the patient had no serious bleeding or other complications.
Lessons
Early detection and accurate assessment of pseudoaneurysms are essential for appropriate management. This case shows that contrast-enhanced CT is necessary before CT-guided percutaneous drainage of pancreatic pseudocysts. It also shows that, due to the many complications that pancreatic pseudocysts may cause, appropriate treatment of pseudocysts complicated with pseudoaneurysm has important clinical significance.
