Giant pseudoaneurysm of the splenic artery within walled of pancreatic necrosis on the grounds of chronic pancreatitis

Mitrović, Milica; Šaponjski, Dušan; Stefanović, Aleksandra; Janković, Aleksandra; Milošević, Snežana; Stošić, Katarina; Knežević, Djordje; Kovac, Jelena

doi:10.1016/j.hbpd.2020.02.012

Cited by 3 publications

(6 citation statements)

References 11 publications

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“…В зависимости от топографии, расположения ЛА относительно главного панкреатического протока, в 40-50% случаев возникает кровотечение из большого дуоденального сосочка двенадцатиперстной кишки [2][3][4]. Наиболее частой причиной образования ЛА является острый и хронический панкреатит [3,5,6]. Патогенез ЛА представлен в виде поэтапных процессов на фоне воспаления в паренхиме ПЖ с последующим разрушением эластических волокон артериальной стенки ферментами протеолиза (трипсин и эластаза).…”

Section: Introductionunclassified

“…Патогенез ЛА представлен в виде поэтапных процессов на фоне воспаления в паренхиме ПЖ с последующим разрушением эластических волокон артериальной стенки ферментами протеолиза (трипсин и эластаза). Также некоторыми авторами выдвигается теория, заключающаяся в ишемии прилежащего сосуда вследствие сдавления постнекротической кистой, что приводит к некрозу и деструкции сосудистой стенки [5][6][7].…”

Section: Introductionunclassified

“…В большинстве случаев это случайная находка при обследовании пациента с хроническим панкреатитом [8][9][10]. Поэтому инструментальные методы диагностики являются основными в верификации диагноза [4,6,7]. КТ брюшной полости в режиме ангиографии является «золотым стандартом» и наиболее информативным методом диагностики ЛA [6,8].…”

Section: Introductionunclassified

“…Поэтому инструментальные методы диагностики являются основными в верификации диагноза [4,6,7]. КТ брюшной полости в режиме ангиографии является «золотым стандартом» и наиболее информативным методом диагностики ЛA [6,8]. В 25% случаев даже при использовании компьютерной томографии и УЗИ органов брюшной полости с дополнительным доплеровским исследованием не удается визуализировать ложную аневризму селезеночной артерии из-за ее небольших размеров, и только проведение КТ в режиме ангиографии поможет специалисту установить достоверный диагноз [5,6,9].…”

Section: Introductionunclassified

“…Еще одним преимуществом является возможность проведения данного вмешательства под местной анестезией. Также важной особенностью данного вмешательства является высокая эффективность наряду с редко развивающимися осложнениями и сокращение послеоперационного пребывания в стационаре [4,6,7]. Эмболизация окклюзирующими спиралями -наиболее часто применяемый метод РЭ лечения [7].…”

Section: Introductionunclassified

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Splenic artery pseudoaneurysm complicated by haemorrhage into pancreatic pseudocyst: a clinical case

Durleshter

Макаренко

Бухтояров

et al. 2021

Kuban. nauсh. med. vestnik

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Background. Splenic artery pseudoaneurysm is a rare complication of acute and chronic pancreatitis caused by an arterial wall lesion with aggressive pancreatic enzymes and followed by arrosive bleeding into pseudocyst lumen and the formation of a dense fibrous capsule prone to growth.Clinical Case Description. Patient M., 61 yo, was emergently admitted to Territorial Clinical Hospital No. 2 with a preliminary diagnosis: Chronic pancreatitis, incomplete remission. Pancreatic pseudocyst. Condition after endoscopic papillosphincterotomy, pancreatic duct stenting. Gastrointestinal haemorrhage. The patient complained of moderate persistent belting upper abdominal and left subcostal pain, nausea, general weakness, black liquid stool over last five days. Pancreonecrosis in history. Pseudocyst formation in two months, endoscopic papillosphincterotomy and pancreatic stenting in hospital, the aforementioned complaints appeared past three months. Moderate anaemia (haemoglobin 73 g/L, erythrocyte count 2.8 x 1012), hyperamylasaemia (amylase 170 U/L), no other pathology in general and biochemic blood panels. The patient was rendered urgent oesophagogastroduodenoscopy for large duodenal papilla, with no evident bleeding detected. Abdominal CT angiography revealed a haemorrhagic mass connected with splenic artery lumen in the projection of pancreatic tail. The patient was transferred to an interventional radiology room for coil embolisation of splenic artery. The postoperative period was benign, and the patient discharged on day 3 after surgery for outpatient surgical patronage. Definite clinical diagnosis: Chronic pancreatitis, incomplete remission. Splenic artery pseudoaneurysm with haemorrhage into pancreatic pseudocyst. Condition after endoscopic papillosphincterotomy, pancreatic duct stenting.Conclusion. Splenic artery pseudoaneurysm with haemorrhage into pancreatic pseudocyst is reluctant to early diagnosis due to a lacking definite clinical picture and tractable only at an interdisciplinary institution disposing with a rich diagnostic toolkit and sufficiently qualified medical personnel. Endovascular treatment is overall most effective and enables a reliable aneurysm isolation from the splenic artery basin.

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Section: Introductionunclassified

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Splenic artery pseudoaneurysm complicated by haemorrhage into pancreatic pseudocyst: a clinical case

Durleshter

Макаренко

Бухтояров

et al. 2021

Kuban. nauсh. med. vestnik

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The Definition, Diagnosis, and Management of Giant Splenic Artery Aneurysms and Pseudoaneurysms: A Systematic Review

Rinaldi,

Illuminati,

Caronna

et al. 2024

JCM

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Background/Objectives: Giant splenic artery aneurysms (SAAs) and pseudoaneurysms (SAPs) represent rare conditions, characterized by a diameter greater than or equal to 5 cm. The risk of rupture is increased compared to common SAAs and SAPs, necessitating urgent treatments to prevent it. Methods: This systematic review was conducted through a comprehensive search involving the PubMed, Google Scholar, and Scopus databases. A total of 82 patients and 65 articles were included in the analysis. For each patient, we investigated age, sex, symptoms, comorbidities, the presence of a true or a false aneurysm, the dimensional criteria used to define dilations as giant aneurysms or pseudoaneurysms, the dimension of the two greatest diameters, imaging studies, surgical treatment, post-operative length of stay (LOS), and post-operative follow-up. Results: The results revealed a similar incidence in both genders (43 males vs. 39 females) with a median age of 55.79 years. The most frequently described symptom was pain (59.76%). Thirteen cases were false aneurysms and 69 were true aneurysms. The mean greatest diameter was 9.90 cm. The CT scan was the most utilized imaging study (80.49%). Open, endovascular, and hybrid surgery were performed in 47, 26, and 9 patients, respectively, with complication rates of 14.89%, 23.08%, and 22.22% occurring for each treatment. The post-operative LOS was 12.29 days, 2.36 days, and 5 days, respectively. The median follow-up was 17.28 months overall. No recanalization was observed after endovascular procedures during the follow-up period. Conclusions: The dimensional criterion to define SAAs and SAPs as giant was most frequently that at least one diameter was ≥ 5 cm. The CT scan was the most frequently utilized radiological study to diagnose giant SAAs and SAPs. Finally, endovascular procedures, open surgeries, and hybrid treatments presented similar post-operative complication rates. The post-operative LOS was lower for the endovascular group, and the follow-up period did not show aneurysm recanalization in any patients.

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Possibilities of Transfistula Ultrasound in Predicting Intraoperative Bleeding in Patients with Infected Pancreatic Necrosis

Remizov,

Andreev,

Durleshter

et al. 2024

Урал. мед. журнал

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Introduction. Assessing the risk of intraoperative bleeding is of great importance in the treatment of patients with infected pancreatic necrosis.The aim of the study — determine the role of transfistula ultrasound in assessing the risk of intraoperative bleeding in patients with infected pancreatic necrosis.Materials and methods. From 2015 to 2019, 193 people with infected pancreatic necrosis were treated at Regional Clinical Hospital No. 2 (Krasnodar). At stage 1, drains of various diameters were installed in all patients; at stage 2, necrotic tissue was removed using transfistula videoscopic necrosequestrectomy in 48 patients (24.9 %). Before performing instrumental necrosequestrectomy, a developed diagnostic method was used — transfistula ultrasound scanning — to determine the relationship between the location of foci of necrosis in the pancreas and blood vessels in 22 patients (11.4 %; group 1); the method was not used in 26 people (13.5 %; group 2).Results. The number of accesses created into the omental bursa was as follows: 141 patients (73.1 %) had 3 accesses, 52 people (26.9 %) had 2 accesses; into the retroperitoneal space: 102 patients (52.8 %) had 2 accesses, 51 people (26.4 %) had 1 access. Transfistula videoscopic necrosequestrectomy was performed 35 and 37 times in groups 1 and 2, respectively (p > 0.05). Transfistula ultrasound scanning to assess the risk of intraoperative bleeding was used 33 times in patients in group 1. In group 1, intraoperative bleeding was observed in 5 patients (23.8 %), in group 2 — in 7 patients (26.9 %) (p > 0.05). The volume of blood loss was (436.0±83.6) and (887.0±41.8) ml in groups 1 and 2, respectively (p < 0.05). There were no cases of death due to intraoperative bleeding in either group.Discussion. Transfistula ultrasound scanning makes it possible to stratify patients: into a high-risk group (with intimate adjacency of necrosis to vessels), medium (at a distance of up to 15 mm) and low-risk (with a distant location). In this regard, interventions in high-risk patients were carried out in the X-ray operating room to allow for endovascular hemostasis, which made it possible to reduce the volume of blood loss, as well as to create a supply of transfusion media in advance to replenish the volume of blood volume.Conclusion. The developed method of direct transfistula ultrasound scanning makes it possible to assess the risk of intraoperative bleeding in patients with infected pancreatic necrosis to achieve timely hemostasis and compensate for acute blood loss.

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Giant pseudoaneurysm of the splenic artery within walled of pancreatic necrosis on the grounds of chronic pancreatitis

Cited by 3 publications

References 11 publications

Splenic artery pseudoaneurysm complicated by haemorrhage into pancreatic pseudocyst: a clinical case

Splenic artery pseudoaneurysm complicated by haemorrhage into pancreatic pseudocyst: a clinical case

The Definition, Diagnosis, and Management of Giant Splenic Artery Aneurysms and Pseudoaneurysms: A Systematic Review

Possibilities of Transfistula Ultrasound in Predicting Intraoperative Bleeding in Patients with Infected Pancreatic Necrosis

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