Pancreatitis-associated pseudoaneurysm of the splenic artery presenting as lower gastrointestinal bleeding: treatment with transcatheter embolisation

Abstract

Pancreatitis is a known cause of pseudoaneurysms of the peripancreatic arteries, which can rarely rupture into various adjacent structures and become a source of life-threatening bleeding. The management is challenging and requires an individualised approach and multidisciplinary care. Herein, we present the case of a 24-year-old man in whom a splenic pseudoaneurysm ruptured into the adjacent infected pseudocyst, communicating with the colon by a fistulous tract, causing massive lower gastrointestinal bleeding. This was successfully managed by transcatheter arterial embolisation (TAE).

Diagnosis of double splenic artery pseudoaneurysm: CT scan versus angiography

“…Moreover, there exists discrepancy in the literature on which is the best method for diagnosing pancreatic PAs. While angiography has an established role in PA diagnosis,5 6 in this case report we argue that the role of CT scan should not be underestimated, and hence both techniques could be very well complementary.…”

“…Thus, appropriate diagnosis is crucial. Direct catheter angiography has been assumed to be the standard for diagnosis 5 6. In this case report, however, we present an unusual formation of two PAs along the splenic artery in the setting of chronic pancreatitis.…”

Re-emergence of a splenic artery pseudoaneurysm following rupture presenting as syncope: management with transarterial embolization

“…There is considerable diversity in the presentation of splenic artery pseudoaneurysms (SAPAs), with incidental findings and acute hemodynamic collapse representing the two ends of the spectrum (1). Hemorrhage is the most common finding in patients with SAPA, and the site and amount of bleeding are the main factors leading to the different clinical presentations (1,2). Pancreatic pseudocysts, which coexist in 41% of cases, are among the sites with potential for bleeding, but not the most common (1)(2)(3)(4)(5)(6)(7).…”

“…Hemorrhage is the most common finding in patients with SAPA, and the site and amount of bleeding are the main factors leading to the different clinical presentations (1,2). Pancreatic pseudocysts, which coexist in 41% of cases, are among the sites with potential for bleeding, but not the most common (1)(2)(3)(4)(5)(6)(7). A rupture into a pseudocyst may lead to either a larger pseudoaneurysm or bleeding that can eventually exteriorize into the gastrointestinal tract or intra-/retroperitoneal space (1,7).…”

“…A rupture into a pseudocyst may lead to either a larger pseudoaneurysm or bleeding that can eventually exteriorize into the gastrointestinal tract or intra-/retroperitoneal space (1,7). While transarterial embolization (TAE) has become the treatment option of choice for SAPAs, particularly in patients at high surgical risk, its suitability for the management of ruptured pseudocyst-associated SAPAs remains unclear (1)(2)(3)(4)6).…”