title: The management of multi-site, bleeding, visceral artery pseudoaneurysms, secondary to necrotising pancreatitis.
abstract: We present the case of a 45-year-old man, who presented to his local casualty department with severe epigastric pain following an alcohol binge, and was subsequently diagnosed with acute pancreatitis. Pancreatic necrosis with multiple collections ensued, necessitating transfer to an intensive care unit (ITU) in a tertiary hepatopancreaticobiliary centre. Initially, the patient appeared to slowly improve and was discharged to the ward, albeit following a prolonged ITU admission. However, during his subsequent recovery, he suffered multiple episodes of haematemesis and melaena associated with haemodynamic instability and requiring repeat admission to the ITU. Computerised tomographic angiography, followed by visceral angiography, was used to confirm the diagnosis of multisite visceral artery pseudoaneurysms, secondary to severe, necrotising pancreatitis. Pseudoaneurysms of the splenic, left colic and gastroduodenal arteries were sequentially, and successfully, radiologically embolised over a period of 9 days. Subsequent sequelae of radiological embolisation included a clinically insignificant splenic infarct, and a left colonic infarction associated with subsequent enterocutaneous fistula formation. The patient made a prolonged, but successful, recovery and was discharged from hospital after 260 days as an in-patient. This case illustrates the rare complication of three separate pseudoaneurysms, secondary to acute pancreatitis, successfully managed radiologically in the same patient. This case also highlights the necessity for multidisciplinary involvement in the management of pseudoaneurysms, an approach that is often most successfully achieved in a tertiary setting.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, University College Hospital NHS Trust, London, UK. j.skipworth@ucl.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: Skipworth
authors.forename: D
authors.initials: D
authors.lastname: Raptis
authors.forename: D
authors.initials: D
authors.lastname: Brennand
authors.forename: C
authors.initials: C
authors.lastname: Imber
authors.forename: A
authors.initials: A
authors.lastname: Shankar
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D017541:Aneurysm, False / Q000209:etiology*; D003106:Colon / Q000098:blood supply; D017577:Cutaneous Fistula / Q000209:etiology; D004621:Embolization, Therapeutic; D006396:Hematemesis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007238:Infarction / Q000209:etiology; D007412:Intestinal Fistula / Q000209:etiology; D008297:Male; D008551:Melena / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications*; D013154:Spleen / Q000098:blood supply; D014781:Viscera / Q000098:blood supply*