Dhineshreddy Gurala, MD
Internal Medicine
staten island university hospital
Staten Island, New York
Dhineshreddy Gurala, MBBS, Pretty Sara Idiculla, MBBS, Abhishek Polavarapu, MD, Magda Daoud, MD, Vivek Gumaste, MD, MRCP, SM
Staten Island University Hospital, Northwell Health, Staten Island, NY
Introduction: Pancreatic Pseudoaneurysm is a rare vascular complication of chronic pancreatitis. It may lead to fatal complications if left untreated. Here we report a case of pseudoaneurysm from a gastroduodenal artery in a patient with chronic pancreatitis which was managed successfully with coil embolization.
Case Description/Methods: 30-year old male with history of alcohol abuse, chronic pancreatitis, and splenic vein thrombosis on Xarelto presented to emergency department with epigastric pain. He was recently discharged from the hospital after an episode of acute pancreatitis. On admission, the pain was dull, radiating to the back with nausea but no vomiting, hematemesis or melena. Physical examination was grossly unremarkable. He was hemodynamically stable and blood work was unremarkable except for lipase 318 U/L. Computerized tomography of abdomen showed development of a pseudoaneurysm branching from the gastroduodenal artery with pancreatic inflammatory changes and fluid collections (Figure 1). Interventional Radiology were consulted, angiography was performed with coil embolization of inflow, outflow vessels, and the pseudo aneurysmal sac (Figure 2,3). His hemoglobin remained stable, and his symptoms resolved. Diet was advanced and Xarelto was resumed. He was discharged on the third day to follow up as outpatient.
Discussion: Pancreatic pseudoaneurysms are formed by erosion of the pancreatic or peripancreatic artery into a pseudocyst. These may occur after pancreatitis, as well as after pancreaticobiliary surgery, pancreatic transplantation, trauma, and motor vehicle accident. They are classified according to the artery they originate from, communication with gastrointestinal tract and exposure to pancreatic juice. Most commonly involved is splenic artery due to its proximity to the pancreas, followed by gastroduodenal artery, pancreaticoduodenal arteries, then superior mesenteric, left gastric, hepatic and small intrapancreatic arteries. Gastro-Duodenal Pseudoaneurysm commonly presents as gastrointestinal bleeding secondary to rupture. It can also present as abdominal pain, asymptomatic, rarely as retroperitoneal bleed or bleeding into pancreatic duct or common bile duct, which can cause obstructive jaundice. Treatment modalities include either embolization or surgery. Surgery is necessary when embolization is unsuccessful. Prompt diagnosis and early treatment of pancreatic pseudoaneurysm is mandatory because of potentially life-threatening consequences and increased mortality if left untreated.
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Citation: Dhineshreddy Gurala, MBBS, Pretty Sara Idiculla, MBBS, Abhishek Polavarapu, MD, Magda Daoud, MD, Vivek Gumaste, MD, MRCP, SM. P0983 - A CASE OF PANCREATIC PSEUDOANEURYSM. Program No. P0983. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.