title: Angiographic embolization of arterial hemorrhage following endoscopic US-guided cystogastrostomy for pancreatic pseudocyst drainage.
abstract: Pseudocyst development is a common complication of chronic pancreatitis. Endoscopic cystogastrostomy is an alternative to percutaneous drainage of pancreatic pseudocysts. Endoscopic ultrasound (EUS) guidance is thought to decrease the procedural risk by identifying and avoiding intervening vasculature. With EUS guidance, extreme care should be exercised to identify large gastric vessels in the path of the puncture. Preoperative imaging should be closely scrutinized for the presence of these vessels. In cases of hemorrhage, balloon tamponading is a rapid way to provide temporary control, allowing transfer of the patient for angiographic embolization. We present a case of arterial hemorrhage due to inadvertent puncture of a hypertrophied right gastric artery following EUS-guided cystogastrostomy, which was successfully treated with temporary balloon occlusion and coil embolization.
authors.affiliation: Medical School, University of Virginia, Charlottesville, VA, USA.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Brandon
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Ruden
authors.forename: Ulkü Cenk
authors.initials: UC
authors.lastname: Turba
authors.forename: Uğur
authors.initials: U
authors.lastname: Bozlar
authors.forename: Paul
authors.initials: P
authors.lastname: Yeaton
authors.forename: Klaus D
authors.initials: KD
authors.lastname: Hagspiel
mesh_terms: D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic; D004724:Endoscopy / Q000009:adverse effects; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional / Q000009:adverse effects