Visceral artery pseudoaneurysm in necrotizing pancreatitis: incidence and outcomes

Abstract

Background: Visceral artery pseudoaneurysms (VA-PSA) occur in necrotizing pancreatitis; however, little is known about their natural history. This study sought to evaluate the incidence and outcomes of VA-PSA in a large cohort of patients with necrotizing pancreatitis.

Adolescent Acute Pancreatitis Complicated With Pseudoaneurysms and Venous Thrombosis

“…An arterial pseudoaneurysm is a ruptured vessel with a surrounding hematoma in communication with the vessel lumen. It is the result of injury to the vessel from surrounding inflammation and pancreatic enzymes [ 5 ]. Endovascular intervention for pseudoaneurysms is reportedly equally effective to surgery because of its 79%-100% efficacy [ 6 ], but rebleeding can still occur.…”

Challenging acute gastrointestinal bleeding

“…El interés de este caso radica en lo infrecuente de las complicaciones vasculares arteriales y sobre todo en las que afectan a vasos de pequeño calibre 1 , en la dificultad diagnóstica al solaparse en el tiempo dos patologías completamente independientes entre sí, así como en la distancia presente entre pseudoaneurisma y colección, dado que habitualmente aparecen en contigüidad por disección de la pared vascular 4 . Esto podría venir justificado por la formación de dicha colección en relación no al episodio actual de pancreatitis, sino al acontecido un año antes.…”

Vascular complications of pancreatitis

“…The exposure of visceral arteries to the enzymes may cause autodigestion of the wall leading to necrotizing arteritis, resulting in the weakening of the vessel lumen, causing a PSA formation. They are usually associated with a preexisting pseudocyst but can also occur without a pseudocyst[ 5 , 6 ].…”

“…The true incidence is unknown, but it ranges from 4% to 17% in single-center reports, with a higher incidence in males[ 7 - 9 ]. PSA is reported mostly in alcohol-induced pancreatitis, but the etiologic factor is not exclusive, and pediatric/hereditary pancreatitis cases have also been reported[ 5 , 8 ]. Patients present with abdominal pain or gastrointestinal bleeding secondary to rupture.…”