Pseudoaneurysms and bleeding pseudocysts in chronic pancreatitis: Radiological findings and contribution to diagnosis in 8 cases

Abstract

Pseudoaneurysms and bleeding pseudocysts are rare but life-threatening complications of chronic pancreatitis. This report summarizes our experience in 8 cases collected from among 250 patients admitted for chronic pancreatitis. We describe the radiological findings of nine vascular lesions and especially emphasize the contribution of recent radiological imaging, ultrasound and computed tomography scanning in establishing the diagnosis of vascular complication. We also report a case of successful embolization of a splenic pseudoaneurysm that ruptured into the colon.

Hemorrhagic complications of pancreatitis: Radiologic evaluation with emphasis on CT imaging

“…The prevalence of bleeding pseudocysts was 18% in one series of 102 cysts [5], 12% in another report of 131 cysts [2], and 2-31% in other surveys [6,7]. A prevalence of 3.2% bleeding pseudoaneurysms and pseudocysts was reported in a survey of 250 cases of chronic pancreatitis [8]. The overall incidence of hemorrhagic complications in our patients that includes all forms of pancreatitis, mild or severe, acute or chronic was only 1.3%.…”

“…This later approach is routinely attempted today to obviate the use for emergency surgery which may be very treacherous and which carries high morbidity and mortality risks. Postoperative mortality of 20-30% for bleeding pseudocysts and bleeding pseudoaneurysms and as high as 43% from bleeding sites in the head of the pancreas have been reported [7][8][9][10][11]. It should be underlined however that although emergency angiographic procedures are routinely done following abnormal abdominal CT examinations, venous bleeding, small vessel and capillary bleeding and hemorrhagic pseudocysts can often escape angiographic detection.…”

“…Failure to suspect these complications in patients with histories of pancreatitis with delay in detection has led to high mortality rates of 25-60% [1,2,8,11]. A review of 131 cases of hemorrhage from false aneurysms and pseudocysts before 1983 has yielded an overall mortality of 37% [11].…”

“…1-6). Their most common location are the splenic artery, gastroduodenal, and pancreaticoduodenal arteries with the left gastric artery, middle colic artery, hepatic artery and smaller branches of the splenic artery occasionally affected [1,8,9,11,12].…”

Pankreatitli Hastada Psödoanevrizma Rüptürü Nedeniyle Gelişen GIS Kanaması: BT İle Takip

“…Birçok hastada peptik ülser, hemorajik gastroduodenit, stress ülseri, özo-fagus varisleri ve Mallory Weiss sendromu gibi pankreatitle ilişkisiz durumlar nedeniyle GIS kanamaları olmaktadır (2,4). Pankreatite bağlı psö-doanevrizma, GİS'e peritoneal kaviteye, pankreatik kanala, retroperitoneal alana rüptüre olabilir ve hızla hayatı tehdit eder duruma gelebilir (1)(2)(3)(4)(5). Psödoanevrizmaların çoğu peripankreatik arterlerden gelişmektedir (6).…”