A rare pancreatic pseudoaneurysm in patient with acute pancreatitis and multiple myeloma

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COD: 301-304 Categorie: ,

Giovanni Li Destri, Vanessa Innao, Giuseppe Petrillo, Antonio Di Cataldo

Ann. Ital. Chir., 2011 82: 301-304

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The authors report the case of a 78-year old patient affected by multiple myeloma who develops acute pancreatitis and
pseudoaneurysmal dilatation of the inferior pancreaticoduodenal artery causing erosion of the second portion of the duodenal
wall and hematemesis.
The authors focus first on the supposed etiological relationship between multiple myeloma and acute pancreatitis, and
they assume that the therapeutic treatment for the bone marrow disease (bortezomib) may have triggered the pancreatic
inflammatory response. They then analyze the pathogenesis of the vascular complication which seems to be related to the
lytic action of pancreatic enzymes on the vessel wall which results in the formation of a pseudoaneurysm first and a
pseudocyst then.
The vascular complication was diagnosed by computed tomography (CT) thus avoiding selective angiography which was
considered too invasive for the patient.
The careful and conservative treatment of the complication has allowed for full healing of the cephalopancreatic region,
in addition to avoiding surgery or embolization treatment of the pseudoaneurysm which is accompanied by a mortality
rate as high as 50%.

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