1
|
Siew HQ, Yeh ML. A case of upper gastrointestinal bleeding due to pancreatic pseudoaneurysm rupture. Kaohsiung J Med Sci 2024; 40:413-414. [PMID: 38363154 DOI: 10.1002/kjm2.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/17/2024] Open
Affiliation(s)
- Hui-Qi Siew
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Lun Yeh
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| |
Collapse
|
2
|
Chavan R, Baraldo S, Patel N, Gandhi C, Rajput S. Technical tips for EUS-guided embolization of varices and pseudoaneurysms. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2024; 9:211-219. [PMID: 38618622 PMCID: PMC11009482 DOI: 10.1016/j.vgie.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Backgrounds and Aims EUS-guided vascular intervention has expanded the horizons of diagnostic as well as therapeutic interventions for vascular pathology. EUS-guided embolization is a commonly performed technique for the treatment of gastric varices. However, there is a lack of data on the standardization of the technique. Here, we review the techniques and difficulties encountered during EUS-guided embolization of varices and pseudoaneurysms. Methods This article and accompanying video describe the EUS-guided embolization techniques for various vascular lesions. EUS-guided embolization was achieved by combination therapy using coils and cyanoacrylate. Complete obliteration of the lesions was documented on follow-up. The existing literature of EUS-guided embolization therapy is also reviewed. Results Patients with various vascular lesions, including gastric varices, ectopic duodenal varices, and splenic artery pseudoaneurysms, were successfully treated with EUS-guided coil plus cyanoacrylate injection. Patients with gastric varices underwent treatment with 2 EUS-guided techniques: (1) direct puncture of the varix and embolization and (2) feeder vessel embolization. Following embolization, the absence of Doppler flow within the varix and pseudoaneurysm was documented. Conclusions Techniques of EUS-guided embolization of varices and pseudoaneurysms are demonstrated. Understanding the techniques and the challenges encountered during therapy is crucial to optimize outcomes and reduce adverse events.
Collapse
Affiliation(s)
| | | | - Nishant Patel
- Arnold Palmer Hospital for Children, Orlando Health, Orlando, Florida, USA
| | | | | |
Collapse
|
3
|
Bejcek A, Ancha A, Amundsen T, Rodich S, Smith S, Johnson C. Marginal Artery of Drummond Masquerading as a Fistulous Tract Resulting in Recurrent Lower Gastrointestinal Bleeding. ACG Case Rep J 2023; 10:e01193. [PMID: 37928236 PMCID: PMC10624456 DOI: 10.14309/crj.0000000000001193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 09/27/2023] [Indexed: 11/07/2023] Open
Abstract
Lower gastrointestinal bleeding (LGIB) can be caused by a variety of causes. Pseudoaneurysms have been described as a rare etiology of LGIB and are associated with pancreatic pseudocysts that involve adjacent vasculature. Our study describes a 38-year-old man with recent severe coronavirus disease 2019 and necrotizing pancreatitis presenting with hematochezia and blood clots by gastrostomy-jejunostomy. Initial flexible sigmoidoscopy did not elicit an etiology for the LGIB. Recurrent hematochezia prompted colonoscopy and angiography, which demonstrated a pseudoaneurysm in the marginal artery of Drummond as the source. Our case highlights the importance of repeat evaluation of gastrointestinal bleeding of unknown etiology.
Collapse
Affiliation(s)
- Alexis Bejcek
- Division of Gastroenterology, Department of Medicine, Baylor Scott & White Medical Center, Temple, TX
| | - Anupama Ancha
- Division of Internal Medicine, Department of Medicine, Baylor Scott & White Medical Center, Temple, TX
| | - Tyson Amundsen
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Sean Rodich
- Department of Radiology, Baylor Scott & White Medical Center, Temple, TX
| | - Steven Smith
- Division of Gastroenterology, Department of Medicine, Hendrick Medical Center, Abilene, TX
| | - Christopher Johnson
- Division of Gastroenterology, Department of Medicine, Baylor Scott & White Medical Center, Temple, TX
| |
Collapse
|
4
|
Barka M, Rguez A, Ben Cheikh Y, Chaouch MA, Jarrar MS, Ben Abdessalem Z, Hamila F, Youssef S. A case report of gastroduodenal artery pseudoaneurysm and giant pancreatic pseudocyst following acute pancreatitis revealed by obstructive jaundice. SAGE Open Med Case Rep 2023; 11:2050313X231188885. [PMID: 37529080 PMCID: PMC10387759 DOI: 10.1177/2050313x231188885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/03/2023] [Indexed: 08/03/2023] Open
Abstract
Acute necrotic pancreatitis is an emergency of evolution and is often unpredictable because of the potentially life-threatening complications it can cause. We report a unique case of a 56-year-old woman hospitalized for acute necrotic pancreatitis. The evolution of the latter was characterized by the occurrence of two very rare complications, of which the clinical presentations were atypical. The first complication was a gastroduodenal pseudoaneurysm compressing the main biliary tract and causing obstructive jaundice, which evolved well following percutaneous embolization. The second complication was a giant 20 cm pancreatic pseudocyst revealed by obstructive jaundice secondary to biliary compression, which progressed well following surgical treatment.
Collapse
Affiliation(s)
- Malek Barka
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Arib Rguez
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Yasser Ben Cheikh
- Department of Radiology, Sahloul University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Mohamed Ali Chaouch
- Department of General and Digestive Surgery, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia
| | - Mohamed Salah Jarrar
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Zied Ben Abdessalem
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Fehmi Hamila
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Sabri Youssef
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| |
Collapse
|
5
|
Kalsi H, Jue TL, Pannala R. Arterial Pseudoaneurysm Mimicking a Mural Nodule Within a Pancreatic Cyst. ACG Case Rep J 2023; 10:e01080. [PMID: 37389193 PMCID: PMC10306426 DOI: 10.14309/crj.0000000000001080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 05/24/2023] [Indexed: 07/01/2023] Open
Abstract
Pancreatic cysts with high-risk characteristics are at increased risk of harboring high-grade dysplasia or pancreatic cancer. Endoscopic ultrasound may clarify the nature of the cystic lesion and its malignant potential. A mural nodule found through endoscopic ultrasound within a cyst may represent malignancy and require fine-needle aspiration. Pancreatic pseudocysts are benign walled-off fluid collections that form in the setting of pancreatitis and may be difficult to differentiate from neoplastic cysts. Pseudoaneurysms form when pancreatitis inflammation damages vessel walls and can cause fatal hemorrhage. We present a pancreatic pseudocyst with pseudoaneurysm mimicking a neoplastic cyst with a mural nodule.
Collapse
Affiliation(s)
| | - Terry L. Jue
- Department of Gastroenterology & Hepatology, Mayo Clinic, AZ
| | - Rahul Pannala
- Department of Gastroenterology & Hepatology, Mayo Clinic, AZ
| |
Collapse
|
6
|
Transarterial Embolization of Ruptured Pancreaticoduodenal Artery Pseudoaneurysm Related to Chronic Pancreatitis. Diagnostics (Basel) 2023; 13:diagnostics13061090. [PMID: 36980398 PMCID: PMC10047043 DOI: 10.3390/diagnostics13061090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
We presented a 67-year-old woman with lightheadedness, diaphoresis, and acute epigastric and right hypochondrium pain, with a past medical history including stage 2 essential hypertension, chronic ischemic cardiomyopathy, and class 1 obesity. An abdominal contrast-enhanced CT scan showed an extensive hematoma (3 × 4 cm2 in size) located intra-abdominally, adjacent to the duodenojejunal area, with hyperdensity around the duodenum, positioned inferior to the pancreas (30–59 HU). Moreover, the CT scan also revealed an enhancing lesion as a pseudoaneurysm of the inferior pancreaticoduodenal artery, measuring 5 × 8 × 8 mm3 with active bleeding and associated hematoma. Following these investigations of the abdominal area, a decision was made to proceed with an endovascular intervention within the interventional radiology department. With the patient under conscious sedation, via a right common femoral artery approach, the superior mesenteric artery was catheterized. While injecting the contrast agent to obtain a better working projection, the pseudoaneurysm ruptured, and acute extravasation of the contrast agent was noted, followed by injection of a mixture of 1 mL Glubran 2 with 2 mL Lipiodol until complete obliteration of the pseudoaneurysm was obtained. The patient was hemodynamically stable at the end of the procedure and was discharged 6 days later in a good condition without active bleeding signs.
Collapse
|
7
|
Ghazanfar H, Jyala A, Kandhi SD, Shin D, Samsuddoha K, Patel H. Ruptured Gastroduodenal Artery Pseudoaneurysms as a Complication of Pancreatitis. Case Rep Gastroenterol 2023; 17:294-301. [PMID: 37928971 PMCID: PMC10623810 DOI: 10.1159/000533617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 08/08/2023] [Indexed: 11/07/2023] Open
Abstract
Visceral artery pseudoaneurysms is a known vascular complication of pancreatitis that can lead to life-threatening hemorrhages with a high mortality rate if left untreated. We present a case of ruptured gastroduodenal artery pseudoaneurysm in a 68-year-old male with acute pancreatitis presenting with fatal gastrointestinal and retroperitoneal bleeding that was successfully managed with endovascular coil embolization of the involved vasculature. Patients with hemorrhagic pancreatitis or those presenting with unexplained retroperitoneal or gastrointestinal bleeding in the setting of pancreatitis with an unexplained drop in hematocrit or sudden expansion of pancreatic fluid collection should be screened in a timely manner for pseudoaneurysm using CT angiogram of the abdomen, which is the gold standard imaging modality to identify pseudoaneurysms. Once pseudoaneurysm is diagnosed, it should be treated immediately. Endovascular treatment options are now favored over surgical options in most cases.
Collapse
Affiliation(s)
- Haider Ghazanfar
- Department of Gastroenterology, Bronxcare Health System, Bronx, NY, USA
| | - Abhilasha Jyala
- Department of Gastroenterology, Bronxcare Health System, Bronx, NY, USA
| | | | - Dongmin Shin
- Department of Gastroenterology, Bronxcare Health System, Bronx, NY, USA
| | - Kazi Samsuddoha
- Department of Pathology, Bronxcare Health System, Bronx, NY, USA
| | - Harish Patel
- Department of Gastroenterology, Bronxcare Health System, Bronx, NY, USA
| |
Collapse
|
8
|
Kalas MA, Leon M, Chavez LO, Canalizo E, Surani S. Vascular complications of pancreatitis. World J Clin Cases 2022; 10:7665-7673. [PMID: 36158481 PMCID: PMC9372863 DOI: 10.12998/wjcc.v10.i22.7665] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/01/2022] [Accepted: 06/30/2022] [Indexed: 02/06/2023] Open
Abstract
More than 200000 hospital admissions happen per year for acute pancreatitis and more than 50000 for chronic pancreatitis in the United States of America. Necrotizing pancreatitis accounts for 20%-30% of the cases. One-quarter of the patients with pancreatitis develop vascular complications, which carries a high mortality. This mini-review will address these complications that can help primary care physicians and hospitalists in managing their patients effectively.
Collapse
Affiliation(s)
- M Ammar Kalas
- Department of Medicine, Texas Tech University Health Center, El Paso, TX 79905, United States
| | - Monica Leon
- Department of General Surgery, Centro Medico ABC, Ciudad de Mexico 01120, Mexico
| | - Luis Omar Chavez
- Department of Medicine, Texas Tech University Health Center, El Paso, TX 79905, United States
| | - Eduardo Canalizo
- Department of General Surgery, Centro Medico ABC, Ciudad de Mexico 01120, Mexico
| | - Salim Surani
- Department of Medicine, Texas A&M University, Bryan, TX 77807, United States
| |
Collapse
|
9
|
Zi’ang YBS, Xia XBS. Ultrasound of Pancreaticoduodenal Pseudoaneurysm without Obvious Cause, A Case Report. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2022. [DOI: 10.37015/audt.2022.210029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
10
|
Gaur NK, Shaikh O, S SS, Reddy A, Kumbhar U. Left Gastric Artery Pseudoaneurysm Due to Pancreatitis. Cureus 2021; 13:e20405. [PMID: 35036230 PMCID: PMC8754357 DOI: 10.7759/cureus.20405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 11/22/2022] Open
Abstract
Acute or chronic pancreatitis can cause pseudoaneurysms of visceral arteries. The left gastric artery (LGA) is the least common visceral artery being affected. Here, we report a case of chronic pancreatitis with a pseudoaneurysm of the LGA. A 42-year-old male, a chronic alcoholic, and smoker, presented with abdominal pain, haematemesis, and melena. Diagnosis of pseudoaneurysm of LGA aneurysm was confirmed by computed tomography abdomen. The endovascular coil embolization was done successfully, following which the patient had an uneventful recovery.
Collapse
|
11
|
Singh P, Scibelli N, Gosal K, Bostick A, Morgan DC. Hepatic Artery Pseudoaneurysm Presenting as Gastrointestinal Hemorrhage. Cureus 2021; 13:e14190. [PMID: 33936900 PMCID: PMC8083905 DOI: 10.7759/cureus.14190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A hepatic artery pseudoaneurysm (HAP) is a rare complication of laparoscopic cholecystectomy. It can vary in its clinical presentation; however, given its severe nature, prompt assessment and management are crucial. We report a case of a 73-year-old male who underwent a laparoscopic cholecystectomy complicated by a right hepatic artery injury. This subsequently presented as a life-threatening case of upper gastrointestinal bleeding from HAP, with presumable hemobilia and septic shock from multiple liver abscesses. The diagnosis was made with computed tomography angiography (CTA) of the abdomen and pelvis followed by visceral angiography. The patient ultimately underwent a right hepatectomy for definitive treatment. The primary objective of this case is to highlight a less novel, though rare, case presentation and define a spectrum of treatment options available based on severity.
Collapse
Affiliation(s)
- Pratishtha Singh
- Internal Medicine, Grand Strand Regional Medical Center, Myrtle Beach, USA
| | | | - Kiranpreet Gosal
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | - Adam Bostick
- Pulmonary and Critical Care Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| | - Dylan C Morgan
- Internal Medicine, Grand Strand Medical Center, Myrtle Beach, USA
| |
Collapse
|
12
|
Chapa UK, Dutta S, Abhinaya R, Jain A, Kalyanasundaram A, Munuswamy H, Ramakrishnaiah VPN. Giant Celiac Artery Pseudoaneurysm in a Case of Chronic Pancreatitis: A Rare Case Report With Literature Review. Vasc Endovascular Surg 2021; 55:658-662. [PMID: 33739212 DOI: 10.1177/15385744211002497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pancreatic pseudoaneurysms though uncommon can result in life-threatening spontaneous acute gastrointestinal or intraperitoneal hemorrhage. Celiac artery pseudoaneurysm in a background of chronic pancreatitis is a very rare event. Digital Subtraction Angiography is an important adjunct in the diagnosis and follow-up with the advantage of providing therapeutic options along with giving other details regarding the site, size, and flow characteristics. It has replaced emergency surgical procedures with the added advantage of fewer postoperative complications and lower morbidity and mortality. An urgent surgical intervention remains the only option when such endovascular management fails, not feasible, or is unavailable. Surgical options include proximal arterial ligation or a pancreatic resection, depending on the location of the pseudoaneurysm. We report a case of a 35-year-old gentleman, a known patient of chronic pancreatitis, who presented to our emergency with clinical features of hypovolemic shock and was diagnosed to have celiac artery pseudoaneurysm. Following a failed endovascular coiling, he was successfully managed with operative celiac artery ligation.
Collapse
Affiliation(s)
- Uday Kumar Chapa
- Division of GI & HPB Surgery, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Souradeep Dutta
- Division of GI & HPB Surgery, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Reddy Abhinaya
- Division of GI & HPB Surgery, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Ankit Jain
- Division of GI & HPB Surgery, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Aravind Kalyanasundaram
- Department of Cardiothoracic and Vascular Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Hemachandren Munuswamy
- Department of Cardiothoracic and Vascular Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | | |
Collapse
|
13
|
Wongwaisayawan S, Papadatos D, Aina R, Sheikh A. Ruptured Pancreaticoduodenal Artery Pseudoaneurysm in an Unusual Location in a Patient with Chronic Pancreatitis: A Case Report. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0040-1716804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractBleeding 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.
Collapse
Affiliation(s)
- Sirote Wongwaisayawan
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Ratchathewi, Bangkok, Thailand
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Demetri Papadatos
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Rima Aina
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Adnan Sheikh
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| |
Collapse
|