Document Detail

The management of multi-site, bleeding, visceral artery pseudoaneurysms, secondary to necrotising pancreatitis.
MedLine Citation:
PMID:  19220939     Owner:  NLM     Status:  MEDLINE    
We present the case of a 45-year-old man, who presented to his local casualty department with severe epigastric pain following an alcohol binge, and was subsequently diagnosed with acute pancreatitis. Pancreatic necrosis with multiple collections ensued, necessitating transfer to an intensive care unit (ITU) in a tertiary hepatopancreaticobiliary centre. Initially, the patient appeared to slowly improve and was discharged to the ward, albeit following a prolonged ITU admission. However, during his subsequent recovery, he suffered multiple episodes of haematemesis and melaena associated with haemodynamic instability and requiring repeat admission to the ITU. Computerised tomographic angiography, followed by visceral angiography, was used to confirm the diagnosis of multisite visceral artery pseudoaneurysms, secondary to severe, necrotising pancreatitis. Pseudoaneurysms of the splenic, left colic and gastroduodenal arteries were sequentially, and successfully, radiologically embolised over a period of 9 days. Subsequent sequelae of radiological embolisation included a clinically insignificant splenic infarct, and a left colonic infarction associated with subsequent enterocutaneous fistula formation. The patient made a prolonged, but successful, recovery and was discharged from hospital after 260 days as an in-patient. This case illustrates the rare complication of three separate pseudoaneurysms, secondary to acute pancreatitis, successfully managed radiologically in the same patient. This case also highlights the necessity for multidisciplinary involvement in the management of pseudoaneurysms, an approach that is often most successfully achieved in a tertiary setting.
J Skipworth; D Raptis; D Brennand; C Imber; A Shankar
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2009-02-13
Journal Detail:
Title:  Annals of the Royal College of Surgeons of England     Volume:  91     ISSN:  1478-7083     ISO Abbreviation:  Ann R Coll Surg Engl     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-01     Completed Date:  2009-06-29     Revised Date:  2010-09-23    
Medline Journal Info:
Nlm Unique ID:  7506860     Medline TA:  Ann R Coll Surg Engl     Country:  England    
Other Details:
Languages:  eng     Pagination:  255-8     Citation Subset:  IM    
Department of Hepatobiliary and Pancreatic Surgery, University College Hospital NHS Trust, London, UK.
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MeSH Terms
Abdominal Pain / etiology
Aneurysm, False / etiology*
Colon / blood supply
Cutaneous Fistula / etiology
Embolization, Therapeutic
Hematemesis / etiology*,  therapy
Infarction / etiology
Intestinal Fistula / etiology
Melena / etiology*,  therapy
Middle Aged
Pancreatitis, Acute Necrotizing / complications*
Spleen / blood supply
Viscera / blood supply*

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