title: Pseudoaneurysm of the splenic artery - an uncommon cause of delayed hemorrhage after pancreaticoduodenectomy.
abstract: Delayed post-pancreatectomy hemorrhage (PPH) is a relatively uncommon, but feared, complication after pancreaticoduodenectomy (PD). A splenic artery pseudoaneurysm is a rare cause of delayed PPH after a PD. This paper describes the case of a patient with PD used to treat a distal bile duct cholangiocarcinoma complicated with a clinically significant pancreatic fistula and secondary intraabdominal abscess. Computed tomography-guided drainage of the abscess was performed with an apparently favourable outcome; the patient was discharged on postoperative day (POD) 35 and the abdominal drains were removed on POD 50. On POD 80, the patient was readmitted for a severe digestive hemorrhage. Computed tomography revealed a pseudoaneurysm of the splenic artery with a subsequent hematoma formation. Immediately, an angiography was performed and coils were successfully mounted. This case illustrates the rare possibility of the development of a splenic artery pseudoaneurysm with severe delayed PPH after PD complicated with a clinically significant pancreatic fistula, even after the patient was discharged from the hospital. An interventional radiology approach represents the first treatment option in hemodynamically stable patients with high success rates.
authors.affiliation: Center of Interventional Radiology and Medical Imaging, Fundeni Clinical Institute, Bucharest, Romania.
authors.forename: Radu
authors.initials: R
authors.lastname: Dumitru
authors.affiliation: Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania.
authors.forename: Ana
authors.initials: A
authors.lastname: Carbunaru
authors.affiliation: Center of Interventional Radiology and Medical Imaging, Fundeni Clinical Institute, Bucharest, Romania.
authors.forename: Mugur
authors.initials: M
authors.lastname: Grasu
authors.affiliation: Center of Interventional Radiology and Medical Imaging, Fundeni Clinical Institute, Bucharest, Romania.
authors.forename: Mihai
authors.initials: M
authors.lastname: Toma
authors.affiliation: Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania.
authors.forename: Mihnea
authors.initials: M
authors.lastname: Ionescu
authors.affiliation: Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Bucharest, Romania.
authors.forename: Traian
authors.initials: T
authors.lastname: Dumitrascu
keywords: Delayed hemorrhage; Interventional angiography; Pancreatic fistula; Pancreaticoduodenectomy; Splenic artery pseudoaneurysm