[Massive hematemesis resulting from stomach rupture caused by pseudoaneurysm of the splenic artery in a patient with chronic pancreatitis. A case report].
The authors report a case of a pancreatic pseudocyst, due to alcoholic chronic pancreatitis, that was transformed into a pseudoaneurysm of the splenic artery as a result of vascular erosion and that manifested itself with massive haematemesis due to spontaneous fistulisation in the stomach. After defining the incidence of the pancreatic disease and of this unusual form of gastric bleeding, particular attention is devoted to the clinical data and to the aetiopathogenic and physiopathological mechanisms involved in the vascular glandular and periglandular damage, outlining the sources and sites of bleeding. The authors go on to discuss the rationale in using imaging techniques, which cannot ignore the haemodynamic conditions of the patient and the conviction that the execution time of a selective coeliac arteriography never represents an unacceptable delay in the management of a life-threatening ruptured pancreatic pseudoaneurysm. This conviction is due both to the therapeutic potential inherent in the method itself and to the greater safety with which the following operation can be performed, owing to the topographical guidance the procedure provides. After a review of the conditions that make the treatment difficult, the authors stress the importance of a certain measure of eclecticism and careful planning to obtain effective and safe results. Only the combined, integrated efforts of the interventional radiologist and the surgeon can ensure rapid stabilisation of the bleeding and the desired improvement in survival.
Dipartimento di Patologia Umana Cattedra di Chirurgia d'Urgenza e di Pronto Soccorso Università degli Studi di Messina.
Luigi Giuseppe
LG
Angiò
Giovanni
G
Pirrone
Maria Grazia
MG
Fracassi
Enrico
E
Piazzese
Vincenzo
V
Pacilè
Natale
N
Fabiano
Giuseppe
G
Sfuncia
D000328:Adult; D017541:Aneurysm, False / Q000150:complications*; D002908:Chronic Disease; D006396:Hematemesis / Q000209:etiology*; D006801:Humans; D008297:Male; D010195:Pancreatitis / Q000150:complications*; D012422:Rupture, Spontaneous; D013157:Splenic Artery; D013275:Stomach Rupture / Q000150:complications / Q000209:etiology*