[Fissure syndrome of a gastrointestinal artery pseudoaneurysm in contact with a pseudocyst of the pancreas: rare, but serious complication of chronic pancreatitis].
Most pseudoaneurysms (PsA) of the peripancreatic arteries cause direct erosion of the arterial wall from pancreatic enzymes that are usually in contact with or in a pseudocyst (PC). Rupturing is a rare and serious complication (90% mortality if untreated). We report the case of a 56-year-old patient with chronic alcoholic pancreatitis who developed a cephaloisthmic PC, complicated with a PsA of the gastroduodenal artery revealed by pain and deglobulization associated with cholestasis. After a diagnostic scan, emergency selective arteriography with coil embolization was performed. Five days later, hemorrhage recurred and a cephalic duodenopancreatectomy was performed. PsA of the gastroduodenal artery occur in the first 10 years of chronic pancreatitis. They are revealed by abdominal pains and/or gastrointestinal hemorrhage or shock from rupture. A scan with arterial reconstruction provides diagnosis. Arteriography is the most sensitive technique to locate the aneurysm and its branches and to perform selective embolization with coils. The failure rate is between 0 and 23%. Surgical treatment (elective ligation of the artery or partial pancreatic excision) should be limited to when embolisation fails and/or recurrent hemorrhage.
Kianmanesh
R
R
Services de chirurgie generale et digestive, hôpital Louis-Mourier, AP-HP, universite Paris-7, 178, rue des Renouillers, 92700 Colombes, France. reza.kianmanesh@lmr.aphp.fr
Benjelloun
M
M
Scaringi
S
S
Leroy
C
C
Jouet
P
P
Castel
B
B
Sabaté
J-M
JM
Coffin
B
B
Flamant
Y
Y
Msika
S
S
D017541:Aneurysm, False / Q000209:etiology*; D017542:Aneurysm, Ruptured / Q000209:etiology; D004386:Duodenum / Q000098:blood supply*; D004621:Embolization, Therapeutic; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply; D010192:Pancreatic Pseudocyst / Q000150:complications*; D016577:Pancreaticoduodenectomy; D019512:Pancreatitis, Alcoholic / Q000150:complications; D050500:Pancreatitis, Chronic / Q000150:complications; D012008:Recurrence; D013270:Stomach / Q000098:blood supply*; D013577:Syndrome