Pseudoaneurysm complicating pancreatitis: what is the best treatment? Case presentation and review of the literature.

Volume 1, Issue 2, December 2016     |     PP. 207-219      |     PDF (562 K)    |     Pub. Date: December 24, 2016
DOI:    370 Downloads     7305 Views  

Author(s)

Fabio Corvino M.D., Department of Advanced Medical Biosciences, University Federico II of Naples (UNINA), Biostructures and Bioimmages Institution (IBB), National Research Council (CNR), via Pansini 5 I-80131 Naples, Italy.
Antonio Corvino M.D., University of Naples "Parthenope", Via Medina 40, 80133, Naples, Italy.
Luca Centore M.D., Radiology Department, G. Rummo Hospital, via dell'Angelo 1, 82100 Benevento, Italy.
Emilio Soreca M.D., Radiology Department, G. Rummo Hospital, via dell'Angelo 1, 82100 Benevento, Italy.
Alfonso Bencivenga M.D, Radiology Department, G. Rummo Hospital, via dell'Angelo 1, 82100 Benevento, Italy.

Abstract
Pseudoaneurysms secondary to pancreatitis, acute or chronic, are a rare complication (reported incidence in a range from 1.3% to 10%), potentially lethal. An early detection and intervention, either surgical or by minimally invasive interventional procedure, is vital for the patient. Multidetector Computed Tomography is the gold standard for the diagnosis. Endovascular therapy with coil embolization is the first-line option for treating pseudoaneurysms subsequent to pancreatitis acute or chronic.We discuss transcatheter coil embolization treatment and subsequent resolution of a giant pseudoaneurysm resulting from an abnormal pancreatic branch of hepatic artery, with an aberrant origin directly from aorta, caused by an alcoholic chronic pancreatitis in a 35-years-old man with gastrointestinal bleeding and severe anemia.

Keywords
Gastrointestinal Bleeding; Visceral Pseudoaneurysms; Chronic pancreatitis; Coil Embolization; Vascular Complications; Hepatic Artery.

Cite this paper
Fabio Corvino M.D., Antonio Corvino M.D., Luca Centore M.D., Emilio Soreca M.D., Alfonso Bencivenga M.D, Pseudoaneurysm complicating pancreatitis: what is the best treatment? Case presentation and review of the literature. , SCIREA Journal of Clinical Medicine. Volume 1, Issue 2, December 2016 | PP. 207-219.

References

[ 1 ] Mortelé KJ, Mergo PJ, Taylor HM, Wiesner W, Cantisani V, Ernst MD, Kalantari BN, Ros PR. Peripancreatic vascular abnormalities complicating acute pancreatitis: contrast-enhanced helical CT findings. Eur J Radiol. 2004; 52: 67–72
[ 2 ] Verde F, Fishman EK, Johnson PT. Arterial Pseudoaneurysms Complicating Pancreatitis: Literature Review. J Comput Assist Tomogr Month 2015; 39(1): 7-12.
[ 3 ] Hyare H, Desigan S, Nicholl H, Guiney MJ, Brookes JA, Lees WR Multi-section CT angiography compared with digital subtraction angiography in diagnosing major arterial hemorrhage in inflammatory pancreatic disease. Eur J Radiol 2006; 59(2): 295–300.
[ 4 ] Covey AM, Brody LA, Maluccio MA, Getrajdman GI, Brown KT. Variant hepatic arterial anatomy revisited: digital subtraction angiography performed in 600 patients. Radiology. 2002; 224:542–7
[ 5 ] Balthazar EJ, Fisher LA. Hemorrhagic complications of pancreatitis: radiologic evaluation with emphasis on CT imaging. Pancreatology. 2001; 1(4):306–313
[ 6 ] Bergert H, Dobrowolski F, Caffier S, Bloomenthal A, Hinterseher I, Saeger HD. Prevalence and treatment of bleeding complications in chronic pancreatitis. Langenbecks Arch Surg. 2004; 289:504-510.
[ 7 ] Stedman T. Stedman’s Medical Dictionary for the Health Professions and Nursing, Illustrated. 7th ed. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2012.
[ 8 ] Cotran RS, Kumar V, Collins T, et al. Robbins Pathologic Basis of Disease. 6th ed. Philadelphia, PA: Saunders; 1999
[ 9 ] Hsu JT, Yeh CN, Hung CF, Chen HM, Hwang TL, Jan YY, Chen MF. Management and outcome of bleeding pseudoaneurysm associated with chronic pancreatitis. BMC Gastroenterol. 2006; 11, 6:3
[ 10 ] Gupta V, Kumar S, Kumar P, Chandra A. Giant pseudoaneurysm of the splenic artery. JOP 2011; 12:190-193
[ 11 ] Arora A, Tyagi P, Gupta A, et al. Pseudoaneurysm of the inferior phrenic artery presenting as an upper gastrointestinal bleed by directly rupturing into the stomach in a patient with chronic pancreatitis. Ann Vasc Surg. 2012; 26:860.e9–860.e11.
[ 12 ] Saad NE, Saad WE, Davies MG, Waldman DL, Fultz PJ, Rubens DJ. Pseudoaneurysms and the role of minimally invasive techniques in their management. Radiographics. 2005; 25(Suppl. 1):173–89.
[ 13 ] Pang TC, Maher R, Gananadha S, Hugh TJ, Samra JS. Peripancreatic pseudoaneurysms: a management-based classification system. Surg Endosc 2014; 28:2027–2038.
[ 14 ] Kulkarni CB, Moorthy S, Pullra SK, Prabhu NK, Kannan RR, Nazar PK. Endovascular management of pancreatitis related pseudoaneurysms – A single center experience. Gastrointest Interv 2014; 3: 46-53.
[ 15 ] Barge JU, Lopera JE. Vascular complication of Pancreatitis: Role of interventional Therapy. Korean J Radiol. 2012; 13 Suppl 1: S45-S55.
[ 16 ] Balachandra S, Siriwardena AK. Systematic appraisal of the management of the major vascular complications of pancreatitis. Am J Surg. 2005; 190: 489–495.
[ 17 ] Kriwanek S, Gschwantler M, Beckerhinn P, Armbruster C, Roka R. Complications after surgery for necrotising pancreatitis: risk factors and prognosis. Eur J Surg 1999; 165:952–957
[ 18 ] Bresler L, Boissel P, Grosdidier J. Major hemorrhage from pseudocysts and pseudoaneurysms caused by chronic pancreatitis: surgical therapy. World J Surg. 1991; 15:649–652.
[ 19 ] Eckhauser FE, Stanley JC, Zelenock GB, et al. Gastroduodenal and pancreaticoduodenal artery aneurysms: a complication of pancreatitis causing spontaneous gastrointestinal hemorrhage. Surgery. 1980;88:335–344.
[ 20 ] Boufi M, Belmir H, Hartung O, Ramis O, Beyer L, Alimi YS. Emergency stent graft implantation for ruptured visceral artery pseudoaneurysm. J Vasc Surg 2011; 53:1625–1631
[ 21 ] Izaki K, Yamaguchi M, Kawasaki R, Okada T, Sugimura K, Sugimoto K. N-butyl cyanoacrylate embolization for pseudoaneurysms complicating pancreatitis or pancreatectomy. J Vasc Interv Radiol 2011; 22:302–308.
[ 22 ] Zyromski NJ, Vieira C, Stecker M, et al. Improved outcomes in postoperative and pancreatitis-related visceral pseudoaneurysms. J Gastrointest Surg 2007; 11:50–55.
[ 23 ] Kim J, Shin JH, Yoon HK, et al. Transcatheter renal artery embolization with N-butyl cyanoacrylate. Acta Radiol 2012; 53:415–421.
[ 24 ] Kalva SP, Yeddula K, Wicky S, Fernandez del Castillo C, Warshaw Al. Angiographic intervention in patients with a suspected visceral artery pseudoaneurysm complicating pancreatitis and pancreatic surgery. Arch Surg 2011. 146:647-652.
[ 25 ] Tessier DJ, Stone WM, Fowl RJ, Abbas MA, Andrews JC, Bower TC, Gloviczi P. Clinical features and management of splenic artery pseudoaneurysm: case series and cumulative review of literature J Vasc Surg. 2003; 38:969-974.
[ 26 ] Carr JA, Cho JS, Shepard AD, Nypaver TJ, Reddy DJ. Visceral pseudoaneurysms due to pancreatic pseudocysts: rare but lethal complications of pancreatitis. J Vasc Surg. 2000; 32:722-30.
[ 27 ] Luchs S, Antonacci V, Reid S, Pagan-Marin H. Vascular and interventional case of the day. Pancreatic head pseudoaneurysm treated with percutaneous thrombin injection. AJR. 1999; 173:833–4.
[ 28 ] Fitzpatrick J, Bhat R, Young JA. Angiographic embolization is an effective treatment of severe hemorrhage in pancreatitis. Pancreas 2014; 43:436-439.
[ 29 ] Gonzalez JM, Ezzedine S, Vitton V, et al. Endoscopic ultrasound treatment of vascular complications in acute pancreatitis. Endoscopy. 2009; 41:721–724.
[ 30 ] Roach H, Roberts SA, Salter R, et al. Endoscopic ultrasound-guided thrombin injection for the treatment of pancreatic pseudoaneurysm. Endoscopy. 2005; 37:876–878.
[ 31 ] Chaves DM, Costa FF, Matuguma S, et al. Splenic artery pseudoaneurysm treated with thrombin injection guided by endoscopic ultrasound. Endoscopy. 2012; 44(suppl 2):E99–E100.
[ 32 ] Robinson M, Richards D, Carr N. Treatment of a splenic artery pseudoaneurysm by endoscopic ultrasound-guided thrombin injection. Cardiovasc Intervent Radiol. 2007; 30:515–517