Trattamento endovascolare di pseudoaneurisma rotto dell’arteria gastroduodenale in esiti di pancreatite acuta
Gian Luca Baiocchi 1, Tullio Piardi 1, Raffaele Cuomo 1, Giuseppe Battaglia 1, Maurizio Ronconi 1, Arianna Coniglio 1, Roberto Maroldi 1, Nazario Portolani 1
Affiliations
Article Info
1 Università degli Studi di Brescia - Clinica Chirurgica, Dipartimento di Scienze Mediche e Chirurgiche
2 Università degli Studi di Brescia - Cattedra di Radiologia, II Servizio di Radiologia
Abstract
INTRODUCTION: Peripancreatic arterial pseudoaneurysm is a rare but potentially lethal complication of severe acute pancreatitis because it can massively bleed into the gastrointestinal tract. Since surgical treatment of such cases has a high mortality, percutaneous angiographic embolization of bleeding artery has recently been advocated as an alternative therapy. We report a case of acute pancreatitis complicated by gastrointestinal hemorrhage due to a ruptured gastroduodenal artery pseudoaneurysm, in which hemostasis was achieved by transcatheter arterial embolization. CLINICAL CASE: A 65-year-old woman was transferred from another hospital with a diagnosis of severe acute biliary pancreatitis, and having had hematemesis. Upper GI endoscopy detected bleeding from the papilla of Vater, and CT showed hemorrhage in a pseudocyst at the pancreatic head. Angiography revealed active bleeding from an arterial pseudoaneurysm of the gastroduodenal artery: hematemesis was considered to result from rupture of the pseudoaneurysm (hemosuccus). Transcatheter arterial embolization was performed by a 2-step procedure, both through the celiac trunk, that was stenotic, and through the superior mesenteric artery, and hemostasis was achieved. CONCLUSIONS: We conclude that transcatheter arterial embolization is a minimally invasive and highly effective treatment for acute bleeding from a ruptured pseudoaneurysm secondary to acute pancreatitis.
Keywords
- Acute pancreatitis
- Endovascular embolization
- Peripancreatic pseudocystis
- Pseudoaneurysm
