Left Gastric Pseudoaneurysm in a Case of Chronic Pancreatitis: A Case Report With Review of Literature

Nagarajan, Krishnan; Sunilkumar, Devaraj; Ramakrishnaiah, Vishnu Prasad Nelamangala; Amuthabarathi, Mohan

doi:10.1177/1538574420954309

Cited by 8 publications

(9 citation statements)

References 20 publications

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“…Prevalence and main clinical problems: Although pancreatic bleeding in patients with CP is considered uncommon, the prevalence among in-patient cohorts is reportedly 4.6% to 7.7%[ 48 , 49 ]. Splenic artery is the most commonly involved vessel, followed by gastroduodenal and pancreaticoduodenal arteries[ 31 , 50 ].…”

Section: Methodsmentioning

confidence: 99%

Complications of chronic pancreatitis prior to and following surgical treatment: A proposal for classification

Murruste¹,

Kirsimägi²,

Kase³

et al. 2022

WJCC

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BACKGROUND Chronic pancreatitis (CP) is a long-lasting disease frequently associated with complications for which there is no comprehensive pathophysiological classification. AIM The aims of this study were to: Propose a pathophysiological classification of the complications of CP; evaluate their prevalence in a surgical cohort prior to, and following surgical management; and assess the impact of the surgical treatment on the occurrence of new complications of CP during follow-up. We hypothesized that optimal surgical treatment can resolve existing complications and reduce the risk of new complications, with the exclusion of pancreatic insufficiency. The primary outcomes were prevalence of complications of CP at baseline (prior to surgical treatment) and occurrence of new complications during follow-up. METHODS After institutional review board approval, a prospective observational cohort study with long-term follow-up (up to 20.4 years) was conducted. All consecutive single-center adult patients (≥ 18 years of age) with CP according to the criteria of the American Pancreas Association subjected to surgical management between 1997 and 2021, were included. The prevalence of CP complications evaluated, according to the proposed classification, in a surgical cohort of 166 patients. Development of the pathophysiological classification was based on a literature review on the clinical presentation, course, and complications of CP, as well a review of previous classification systems of CP. RESULTS We distinguished four groups of complications: Pancreatic duct complications, peripancreatic complications, pancreatic hemorrhages, and pancreatic insufficiency (exocrine and endocrine). Their baseline prevalence was 20.5%, 23.5%, 10.2%, 31.3%, and 27.1%, respectively. Surgical treatment was highly effective in avoiding new complications in the first and third groups. In the group of peripancreatic complications, the 15-year Kaplan-Meier prevalence of new complications was 12.1%. The prevalence of pancreatic exocrine and endocrine insufficiency increased during follow-up, being 66.4% and 47.1%, respectively, at 15 years following surgery. Pancreatoduodenal resection resulted optimal results in avoiding new peripancreatic complications, but was associated with the highest rate of pancreatic exocrine insufficiency. CONCLUSION The proposed complication classification improves the understanding of CP. It could be beneficial for clinical decision making, as it provides an opportunity for more comprehensive judgement on patient’s needs on the one hand, and on the pros and cons of the treatment under consideration, on the other. The presence of complications of CP and the risk of development of new ones should be among the main determinants of surgical choice.

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Section: Methodsmentioning

confidence: 99%

Complications of chronic pancreatitis prior to and following surgical treatment: A proposal for classification

Murruste¹,

Kirsimägi²,

Kase³

et al. 2022

WJCC

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“…Right gastric artery is rarely involved [ 119 ]. Endovascular management with coils or other embolic agents have been reported with low ischemic risk [ 120 , 121 ]. EUS treatment with glue has been also described [ 104 ].…”

Section: Visceral Artery-related Considerations and Targeted Approachesmentioning

confidence: 99%

Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives

Venturini

Piacentino

Coppola

et al. 2021

JCM

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Visceral artery aneurysms (VAAs) are rare, usually asymptomatic and incidentally discovered during a routine radiological examination. Shared guidelines suggest their treatment in the following conditions: VAAs with diameter larger than 2 cm, or 3 times exceeding the target artery; VAAs with a progressive growth of at least 0.5 cm per year; symptomatic or ruptured VAAs. Endovascular treatment, less burdened by morbidity and mortality than surgery, is generally the preferred option. Selection of the best strategy depends on the visceral artery involved, aneurysm characteristics, the clinical scenario and the operator’s experience. Tortuosity of VAAs almost always makes embolization the only technically feasible option. The present narrative review reports state of the art and new perspectives on the main endovascular and other interventional options in the treatment of VAAs. Embolization techniques and materials, use of covered and flow-diverting stents and percutaneous approaches are accurately analyzed based on the current literature. Visceral artery-related considerations and targeted approaches are also provided and discussed.

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“…6 Gastric artery pseudoaneurysms are less common with less than 50 cases reported in the literature. 7 Imaging plays a pivotal role in diagnosis of the pseudoaneurysm, with Computed Tomography (CT) angiograms providing the most sensitive non-invasive imaging modality. 7 Digital Subtraction Angiography (DSA) is usually performed immediately prior to embolisation in the IR suite.…”

Section: Introductionmentioning

confidence: 99%

“…7 Imaging plays a pivotal role in diagnosis of the pseudoaneurysm, with Computed Tomography (CT) angiograms providing the most sensitive non-invasive imaging modality. 7 Digital Subtraction Angiography (DSA) is usually performed immediately prior to embolisation in the IR suite. The size of the pseudoaneurysm has no correlation with the risk of rupture, and there are no reliable signs to predict impending rupture.…”

Section: Introductionmentioning

confidence: 99%

Successful Treatment of a Left Gastric Artery Pseudoaneurysm by Image Guided Percutaneous Thrombin Injection

Thomson

Patel

Moser

et al. 2022

Vasc Endovascular Surg

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Visceral artery pseudoaneurysms are common complications of pancreatitis that carry a high mortality rate. The splenic artery is the commonest artery involved. Gastric artery pseudoaneurysms are less common with less than 50 cases reported in the literature. A 58-year-old female was referred to the Interventional Radiology department with a left gastric artery pseudoaneurysm secondary to acute pancreatitis. Initial Digital Subtraction Angiography revealed the pseudoaneurysm arising from the left gastric artery. Several attempts to cannulate the pseudoaneurysm were unsuccessful due to arterial spasm. Consequently, the left gastric artery proximal to the pseudoaneurysm was embolised with 300 microns of polyvinyl alcohol and two coils. 24 hours post-procedure, a computed tomography (CT) scan was performed which revealed a blush of contrast enhancement within the pseudoaneurysm sac, consistent with unsuccessful embolisation. Using a combination of ultrasound and cone beam CT guidance, a 22-gauge Chiba needle was advanced percutaneously via a transhepatic approach to the patent segment of the pseudoaneurysm. 2.5 ml of human thrombin was then injected directly into the pseudoaneurysm. Image guided injection of thrombin has become a well-recognised treatment for a variety of peripheral and visceral pseudoaneurysms and is often performed following a failed attempt of routine endovascular embolisation. We report the case of a patient affected by a pseudoaneurysm of the left gastric artery, treated with a CT guided percutaneous thrombin injection directly into the pseudoaneurysm. This demonstrates that percutaneous coagulation can be an adjunct or an alternative to endovascular embolisation.

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Left Gastric Pseudoaneurysm in a Case of Chronic Pancreatitis: A Case Report With Review of Literature

Cited by 8 publications

References 20 publications

Complications of chronic pancreatitis prior to and following surgical treatment: A proposal for classification

Complications of chronic pancreatitis prior to and following surgical treatment: A proposal for classification

Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives

Successful Treatment of a Left Gastric Artery Pseudoaneurysm by Image Guided Percutaneous Thrombin Injection

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