title: Non-operative Management of Necrotic Pancreatic Collection and Bleeding Pseudoaneurysm Communicating with Bowel Lumen at Multiple Sites: a Case Report and Review of the Literature.
abstract: Pancreatic pseudocysts and foci of walled-off necrosis (WON) are well-known complications of acute pancreatitis. We present a case of severe gallstone pancreatitis complicated by WON, fistulization to the bowel and gastrointestinal bleeding. Bleeding was localized to a pseudoaneurysm of the gastroduodenal artery within the WON using imaging and endoscopy. Angiography and image-guided therapy were then used to control bleeding with coil-embolization. To our knowledge, this is the first report of non-operative management of a patient with severe pancreatitis complicated by WON and a bleeding pseudoaneurysm with multiple communications to the hollow viscera. Therapeutic options are discussed and a thorough literature review is included.
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada; Department of Health Policy and Management, Harvard School of Public Health, Boston MA, USA. roshan.razik@mail.harvard.edu.
authors.forename: Roshan
authors.initials: R
authors.lastname: Razik
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Toronto; Division of Gastroenterology, Therapeutic Endoscopy Program, St. Michael's Hospital, Toronto, Canada.
authors.forename: Gary R
authors.initials: GR
authors.lastname: May
authors.affiliation: Division of Gastroenterology, Department of Medicine; Division of Gastroenterology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
authors.forename: Fred
authors.initials: F
authors.lastname: Saibil
mesh_terms: D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D004621:Embolization, Therapeutic; D016099:Endoscopy, Gastrointestinal; D005260:Female; D042882:Gallstones / Q000150:complications* / Q000175:diagnosis; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome