Trattamento endovascolare di pseudoaneurisma rotto dell’arteria gastroduodenale in esiti di pancreatite acuta


COD: 145-148 Categorie: ,

Gian Luca Baiocchi, Tullio Piardi, Raffaele Cuomo, Giuseppe Battaglia, Maurizio Ronconi, Arianna Coniglio, Roberto Maroldi, Nazario Portolani

Ann. Ital. Chir., 2008; 78: 145-148

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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.