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Liu C, Zhu Q, Zhang H, Wang Z. Gastrointestinal bleeding caused by splenic artery pseudoaneurysm in chronic pancreatitis: a case report and literature review. J Surg Case Rep 2024; 2024:rjae574. [PMID: 39280021 PMCID: PMC11393571 DOI: 10.1093/jscr/rjae574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 08/24/2024] [Indexed: 09/18/2024] Open
Abstract
Pseudoaneurysm of the splenic artery is a rare vascular complication of chronic pancreatitis, with a high mortality rate. Haemorrhage and abdominal pain are the most common manifestations, and so far there are no literature reviews on the rare complication of splenic artery pseudoaneurysm due to chronic pancreatitis. Therefore, we describe a male patient with worsening haemochezia and upper abdominal pain, who had been hospitalized repeatedly for 'pancreatitis' 1 year ago, and relevant investigations confirmed a pseudoaneurysm of the splenic artery, which was successfully treated by transarterial embolization, and a literature review is also presented.
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Affiliation(s)
- Chenyao Liu
- Department of Gastroenterology, Southwest Medical University, Luzhou, Sichuan Province 646000, China
| | - Qingliang Zhu
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province 646000, China
| | - Hailong Zhang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province 646000, China
| | - Zhongqiong Wang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province 646000, China
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Carriero S, Lanza C, Biondetti P, Renzulli M, Bonelli C, Piacentino F, Fontana F, Venturini M, Carrafiello G, Ierardi AM. Imaging-Guided Percutaneous Puncture and Embolization of Visceral Pseudoaneurysms: Feasibility and Outcomes. J Clin Med 2022; 11:jcm11112952. [PMID: 35683341 PMCID: PMC9181803 DOI: 10.3390/jcm11112952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 02/01/2023] Open
Abstract
Visceral artery pseudoaneurysms (VAPAs) are the most frequently diagnosed pseudoaneurysms (PSAs). PSAs can be asymptomatic or symptomatic. The aim of our study was to evaluate the safety and effectiveness of percutaneous embolization of VAPAs performed on patients with an unfeasible trans-arterial approach. Fifteen patients with fifteen visceral PSAs, with a median dimension of 21 mm (IQR 20–24 mm), were retrospectively analyzed. No patients were suitable for trans-arterial catheterization and therefore a percutaneous approach was chosen. During percutaneous treatments, two embolic agents were used, either N-butyl cyanoacrylate (NBCA) (Glubran II, GEM Milan, Italy) mixed with Lipiodol (Lipiodol, Guerbet, France) or thrombin. The outcomes of this study were technical success, primary clinical success, and secondary clinical success. In our population the 15 PSA were located as follows: 2 in the left gastric artery, 1 in the right gastric artery, 3 in the right hepatic artery, 2 in a jejunal artery, 1 in left colic artery branch, 1 in a right colic artery branch, 1 in the gastroepiploic artery, 1 in the dorsal pancreatic artery, 1 in an ileocolic artery branch, 1 in an iliac artery branch, and 1 in a sigmoid artery branch. 80% of PSAs (12/15) were treated with a NBCA:lipiodol mixture and 20% of PSAs (3/15) were treated with thrombin. Technical, primary, and secondary clinical successes were obtained in 100% of the cases. No harmful or life-threatening complications were observed. Minor complications were registered in 26.6% (4/15) of the patients. Percutaneous embolization of visceral PSA is a safe and effective treatment and should be considered as an option when the endovascular approach is unsuccessful or unfeasible.
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Affiliation(s)
- Serena Carriero
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy;
| | - Carolina Lanza
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy;
- Correspondence:
| | - Pierpaolo Biondetti
- Interventional Radiology Unit, Department of Radiology, Foundation IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; (P.B.); (G.C.); (A.M.I.)
- Department of Health Science, Università degli Studi di Milano, 20122 Milan, Italy
| | - Matteo Renzulli
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant’Orsola Hospital, University of Bologna, 40138 Bologna, Italy;
| | - Cristian Bonelli
- Healthcare Professional Department, Foundation IRCSS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy; (F.P.); (F.F.); (M.V.)
- Department of Radiology, Insubria University, 21100 Varese, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy; (F.P.); (F.F.); (M.V.)
- Department of Radiology, Insubria University, 21100 Varese, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy; (F.P.); (F.F.); (M.V.)
- Department of Radiology, Insubria University, 21100 Varese, Italy
| | - Gianpaolo Carrafiello
- Interventional Radiology Unit, Department of Radiology, Foundation IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; (P.B.); (G.C.); (A.M.I.)
- Department of Health Science, Università degli Studi di Milano, 20122 Milan, Italy
| | - Anna Maria Ierardi
- Interventional Radiology Unit, Department of Radiology, Foundation IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy; (P.B.); (G.C.); (A.M.I.)
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Percutaneous puncture and embolisation for pancreatitis-related pseudoaneurysm: the feasibility of thrombin injection even in collection of fluid surrounding the pseudoaneurysm. Pol J Radiol 2019; 83:e510-e513. [PMID: 30655931 PMCID: PMC6334183 DOI: 10.5114/pjr.2018.80302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/02/2018] [Indexed: 12/18/2022] Open
Abstract
Purpose Pancreatitis-related pseudoaneurysm, a potentially life-threatening condition, is treated utilising endovascular management as a first choice and alternatively by percutaneous direct puncture of the aneurysm and embolisation. Case report A 50-year-old man with alcohol-induced necrotic pancreatitis underwent transcatheter arterial embolisation (TAE) for multiple pancreatic pseudoaneurysms. TAE failed in one enlarged aneurysm in the pancreatic body, and percutaneous direct needle puncture and coagulation using thrombin was planned. Precise puncture of the aneurysmal sac under fluoroscopy and computed tomographic (CT) guidance failed, but we could inject about 500 units of thrombin through the outer cannula into the collection of fluid surrounding the aneurysm. Compared to preoperative images, contrast-enhanced CT (CECT) showed shrinkage of the pseudoaneurysm without complications just after the procedure and its disappearance five days after the procedure. Conclusions Percutaneous direct puncture and embolisation is a feasible choice to treat pancreatic pseudoaneurysms, and injection of thrombin even into the collection of fluid surrounding the pseudoaneurysm can be a viable alternative, especially in cases in which precise puncture of the aneurysmal sac is difficult because of its size and location.
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Prette PR, Fagundes FB, Marchon LRC, Maciel RDRT, Martins IM, Riguetti-Pinto CR. Endovascular treatment of acute gastrointestinal bleeding from a large splenic artery pseudoaneurysm: case report and literature review. J Vasc Bras 2018; 17:234-242. [PMID: 30643510 PMCID: PMC6326128 DOI: 10.1590/1677-5449.005517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/19/2018] [Indexed: 11/22/2022] Open
Abstract
Pseudoaneurysm of the splenic artery is a rare entity, with little more than 150 cases described in the literature. Pancreatitis is the most common etiology, followed by trauma. In contrast with true aneurysms, pseudoaneurysms are frequently symptomatic, with a 47% risk of rupture and 90% mortality if left untreated. We describe the case of a 48-year-old female patient who suffered a gastrointestinal hemorrhage associated with acute-on-chronic pancreatitis. During workup, endoscopy revealed signs of recent bleeding and magnetic resonance angiography of the abdomen showed a large pseudoaneurysm of the splenic artery. The patient underwent endovascular treatment with microcoil embolization and no further bleeding episodes occurred. Endovascular treatment is now an effective option with low morbidity and mortality and success rates in the range of 79-100%, making it a viable technique for patients with active abdominal inflammation. We conducted a review of endovascular techniques and embolization agents used to treat this pathology.
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Affiliation(s)
- Paulo Roberto Prette
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
| | - Felipe Borges Fagundes
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
| | - Livia Ramos Carvalho Marchon
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
| | - Rodrigo de Rezende Teixeira Maciel
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
| | - Igor Miguel Martins
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
| | - Cristina Ribeiro Riguetti-Pinto
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto – HUPE, Departamento de Cirurgia Vascular e Endovascular, Rio de Janeiro, RJ, Brasil.
- Curso de Formação em Cirurgia Endovascular – Endocurso, Rio de Janeiro, RJ, Brasil.
- Vascularis Centro de Angiologia e Cirurgia Endovascular, Rio de Janeiro, RJ, Brasil.
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Evans RPT, Mourad MM, Pall G, Fisher SG, Bramhall SR. Pancreatitis: Preventing catastrophic haemorrhage. World J Gastroenterol 2017; 23:5460-5468. [PMID: 28852306 PMCID: PMC5558110 DOI: 10.3748/wjg.v23.i30.5460] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/03/2017] [Accepted: 07/12/2017] [Indexed: 02/06/2023] Open
Abstract
Pancreatitis represents nearly 3% of acute admissions to general surgery in United Kingdom hospitals and has a mortality of around 1%-7% which increases to around 10%-18% in patients with severe pancreatitis. Patients at greatest risk were those identified to have infected pancreatic necrosis and/or organ failure. This review seeks to highlight the potential vascular complications associated with pancreatitis that despite being relatively uncommon are associated with mortality in the region of 34%-52%. We examine the current evidence base to determine the most appropriate method by which to image and treat pseudo-aneurysms that arise as the result of acute and chronic inflammation of pancreas. We identify how early recognition of the presence of a pseudo-aneurysm can facilitate expedited care in an expert centre of a complex pathology that may require angiographic, percutaneous, endoscopic or surgical intervention to prevent catastrophic haemorrhage.
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MESH Headings
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/etiology
- Aneurysm, False/therapy
- Angiography/methods
- Contrast Media/administration & dosage
- Embolization, Therapeutic/methods
- Endoscopy, Gastrointestinal
- Hemorrhage/diagnostic imaging
- Hemorrhage/etiology
- Hemorrhage/therapy
- Hospitalization/statistics & numerical data
- Humans
- Incidence
- Magnetic Resonance Imaging
- Necrosis
- Pancreas/blood supply
- Pancreas/pathology
- Pancreatectomy/adverse effects
- Pancreatectomy/methods
- Pancreatitis, Acute Necrotizing/complications
- Pancreatitis, Acute Necrotizing/epidemiology
- Pancreatitis, Acute Necrotizing/pathology
- Pancreatitis, Chronic/complications
- Pancreatitis, Chronic/diagnostic imaging
- Pancreatitis, Chronic/epidemiology
- Pancreatitis, Chronic/pathology
- Time Factors
- Tomography, X-Ray Computed/methods
- United Kingdom/epidemiology
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