title: Non-surgical management of pancreatic pseudocysts associated with arterial pseudoaneurysm.
abstract: BACKGROUND
  Pseudoaneurysms associated with pancreatic pseudocysts are different from simple, isolated pancreatic pseudoaneurysms and there is paucity of published data on their non surgical treatment.
  
  
  OBJECTIVE
  To retrospectively analyze results of combination of angioembolisation or thrombin injection followed by endoscopic transpapillary drainage for management of pseudoaneurysms associated with pancreatic pseudocysts.
  
  
  METHODS
  Eight patients (all males; mean age ± SD: 31.2 ± 6.1 years; age range: 21-38 years) underwent radiological management of the pseudoaneurysm followed by endoscopic drainage of the pseudocysts.
  
  
  RESULTS
  All patients had pseudocysts (median size 4 cm) with underlying chronic pancreatitis. All patients had abdominal pain on presentation and 7/8 (87.5%) patients had presented with overt gastrointestinal bleeding. The size of the pseudoaneurysms varied from 1 to 4 cm. Two patients were treated with percutaneous thrombin injection whereas six patients underwent digital subtraction angiography and angioembolisation. All patients underwent successful endoscopic transpapillary drainage through the major (5) or minor papilla (3) and resolution of pseudocysts was noted within 6 weeks (median 4 weeks). No significant complication of the procedure was noted in any of the patients.
  
  
  CONCLUSIONS
  Pseudoaneurysms associated with pancreatic pseudocysts can be successfully and safely treated with a combination of radiological obliteration of the pseudoaneurysm followed by endoscopic transpapillary drainage.
authors.affiliation: Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. deepakkbhasin@gmail.com
authors.forename: Deepak Kumar
authors.initials: DK
authors.lastname: Bhasin
authors.forename: Surinder Singh
authors.initials: SS
authors.lastname: Rana
authors.forename: Vishal
authors.initials: V
authors.lastname: Sharma
authors.forename: Chalapathi
authors.initials: C
authors.lastname: Rao
authors.forename: Vivek
authors.initials: V
authors.lastname: Gupta
authors.forename: Rajesh
authors.initials: R
authors.lastname: Gupta
authors.forename: Mandeep
authors.initials: M
authors.lastname: Kang
authors.forename: Kartar
authors.initials: K
authors.lastname: Singh
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D017541:Aneurysm, False / Q000150:complications* / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage / Q000379:methods; D004724:Endoscopy; D006801:Humans; D008297:Male; D010192:Pancreatic Pseudocyst / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D013917:Thrombin / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D013917:Thrombin