Embolisation of metachronous pseudoaneurysms complicating chronic pancreatitis.
BACKGROUND
Pseudoaneurysm bleeding is a well-described complication of chronic pancreatitis. Reports of embolisation therapy for metachronous pseudoaneurysms in this condition are rare. We present such a patient and describe his management.


METHODS
A 5 1-year-old man with chronic pancreatitis who presented with recurrent occult major gastrointestinal bleeding underwent angiography on two separate occasions, 2 years apart. Initial intervention revealed the origin of the coeliac axis to be occluded or absent, and a splenic artery (SA) aneurysm, feeding via the superior mesenteric artery, was embolised. Subsequent angiography after a major bleed showed a new pseudoaneurysm in the head of pancreas feeding from an aberrant hepatic artery, which was embolised. The second angiogram confirmed persistent occlusion of the SA aneurysm and 6 months follow-up showed no evidence of recurrence of the second aneurysm.


CONCLUSIONS
The resolution of these metachronous pseudoaneurysms by angiographic embolisation attests to the validity of this approach as potentially definitive and repeatable therapy.
Pillay
W R
WR
Department of General Surgery, Addington Hospital, University of Natal, Durban, South Africa.
Lalloo
S
S
Thomson
S R
SR
Conrads
M A
MA