Septic course of chronic pancreatitis caused by infected visceral pseudoaneurysm content

Abstract

Visceral pseudoaneurysms occur in approximately 4-10% of all patients with chronic pancreatitis and in untreated cases the mortality rate can reach 90% of cases. The septic course of visceral pseudoaneurysm formation adds major problems to the complex treatment of these patients: Namely the removal of infected material and the occlusion of the ruptured visceral artery significantly complicate treatment strategy. The aim of this report is to present the case of a patient with severe sepsis due to chronic pancreatitis complicated by pseudoaneurysm formation of the gastroduodenal artery in the head of the pancreas. A 32-year-old man underwent semi-urgent surgery after initial haemodynamic stabilization and urgent diagnostic processing including color-coded abdominal duplex sonography, angio-CT, angiography and endoscopic retrograde cholangio-pancreaticography. The removal of infected pseudoaneurysm content was performed and preceded by the extra-pancreatic ligatures of the gastroduodenal and right-sided gastro-epiploic arteries. Blood transfusions could be avoided and the postoperative outcome was uneventful. The rare septic course of visceral pseudoaneurysm complicating chronic pancreatitis may be treated successfully by open surgical technique, with consecutive elimination of the septic focus and the occlusion of ruptured and feeding arteries performed as a one-step procedure.

Diagnosis and management of mycotic aneurysms

“…Presentation Massive upper gastrointestinal bleeding from a ruptured IAA affecting a visceral artery [27,28], severe sepsis in the setting of chronic pancreatitis [29], and intra-abdominal bleeding and shock can all be presentations of visceral IAAs [30][31][32]. More likely clinical scenarios for these problems include patients who are immunosuppressed, undergo organ transplantation, or are otherwise in need of chronic immunosuppression [30,33].…”

Chronic Pancreatitis: A Review

“…Bleeding in CP may be into the peritoneal cavity, into pancreatic duct leading to hemosuccus pancreaticus, into the pseudocyst, or into the GI tract due to pseudoaneurysm. Visceral pseudoaneurysms occur in approximately 4-10 % patients with CP and in untreated cases the mortality can reach up to 90 % [55]. Hemosuccus pancreaticus is rare, but should be considered in patients with CP and gastrointestinal bleeding.…”