[Endovascular treatment for bleeding gastroduodenal pseudoaneurysm after acute pancreatits].
BACKGROUND
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.


METHODS
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.
Baiocchi
Gian Luca
GL
Università degli Studi di Brescia Clinica Chirurgica, Dipartimento di Scienze Mediche e Chirurgiche. baioksurg@hotmail.com
Piardi
Tullio
T
Cuomo
Raffaele
R
Battaglia
Giuseppe
G
Ronconi
Maurizio
M
Coniglio
Arianna
A
Maroldi
Roberto
R
Portolani
Nazario
N
D000208:Acute Disease; D000368:Aged; D017541:Aneurysm, False / Q000150:complications*; D004378:Duodenal Diseases / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D010195:Pancreatitis / Q000150:complications*