Experience of surgical management of pseudo-aneurysms of branches of the coeliac axis in a North Indian Hospital.
BACKGROUND
Bleeding splanchnic artery pseudo-aneurysm is a rare but frequently fatal complication that can be successfully managed by angiographic embolization. However, certain patients because of hemodynamic instability, non-availability of technique or angiographic failure may require primary surgical intervention.


METHODS
Retrospective review of 13 patients presenting with exsanguinating hemorrhage from ruptured pseudo-aneurysm arising from branches of coeliac axis, managed surgically in absence of angiographic embolization.


RESULTS
Splenic artery was most commonly involved (n = 7) followed by hepatic (n = 3), gastroduodenal (n = 2) and left gastric artery (n = 1). The most common underlying aetiology was pancreatitis (n = 8, acute = 2; chronic = 6) followed by iatrogenic (n = 3), liver abscess (n = 1) and gastric ulcer (n = 1). Seven patients presented with upper gastrointestinal (GI) bleed, while 2 each with lower GI bleed, haemobilia and bleeding through tube drains. CT-scan accurately demonstrated the pseudo-aneurysm in 11 (84.6%) patients and additionally demonstrated the underlying pathology. The surgical management chiefly consisted of ligation of offending vessel and additional procedures directed at primary pathology. Overall, 77% patients had a favourable outcome while 23% died consequent to ongoing hemorrhage.


CONCLUSIONS
Pseudo-aneurysm involving the branches of coeliac axis most commonly arises as a result of pancreatitis and affects splenic artery. CT-scan accurately demonstrates pseudo-aneurysm and associated pathology in majority of cases. Primary surgical management in the presence of hemodynamic instability and non-availability of angiographic embolization is a viable alternative.
Negi
S S
SS
G.B. Pant Hospital, University of Delhi, New Delhi-110 002.
Sachdev
A K
AK
Bhojwani
R
R
Singh
S
S
Kumar
N
N
D000293:Adolescent; D000328:Adult; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000601:surgery; D004064:Digestive System / Q000098:blood supply*; D004630:Emergencies; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013157:Splenic Artery