[Colonic necrosis following a pancreatic pseudocyst embolization].
A 43-year-old man with chronic alcohol pancreatitis was admitted in our intensive care unit for an haemorrhagic shock. An abdominal CT-scan performed on admission showed bleeding from a vessel in a pancreatic pseudocyst. Initial treatment included intravenous fluids, transfusion, mechanical ventilation and vasopressive support. Percutaneous arterial embolization (PAE) of a bleeding right superior colon artery was performed with an initial good result. Nevertheless after initial clinical improvement, hypotension refractory to fluid management occurred. An abdominal CT-scan disclosed pneumatosis in right colon. A right hemicolectomy was performed. Histologic analysis confirmed ischemic colitis. The patient recovered and was discharged from the intensive care unit. Colitis necrosis after PAE for pancreatic pseudoaneurysm had never been described before. It should be suspected when haemodynamic instability occurs following PAE.
Legrand
M
M
Service de réanimation polyvalente, centre hospitalier Sud-Francilien, quartier du Canal, 91014 Evry cedex, France. m.legrand@libertysurf.fr
Lecuyer
L
L
Van De Louw
A
A
D000328:Adult; D017541:Aneurysm, False / Q000150:complications / Q000628:therapy*; D002908:Chronic Disease; D003082:Colectomy / Q000379:methods; D017091:Colitis, Ischemic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D003106:Colon / Q000098:blood supply / Q000473:pathology; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D017707:Erythrocyte Transfusion; D005440:Fluid Therapy; D005780:Gelatin / Q000009:adverse effects*; D005781:Gelatin Sponge, Absorbable / Q000008:administration & dosage / Q000009:adverse effects*; D016908:Gram-Positive Bacterial Infections / Q000209:etiology / Q000382:microbiology; D006801:Humans; D007022:Hypotension / Q000209:etiology* / Q000628:therapy; D007778:Lactobacillus; D008297:Male; D009336:Necrosis; D010192:Pancreatic Pseudocyst / Q000150:complications / Q000628:therapy*; D019512:Pancreatitis, Alcoholic / Q000150:complications; D010538:Peritonitis / Q000209:etiology / Q000382:microbiology; D010949:Plasma; D012422:Rupture, Spontaneous; D012771:Shock, Hemorrhagic / Q000209:etiology; D013610:Tachycardia / Q000209:etiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed
D005780:Gelatin