An innovative modification of sandwich embolization technique for simultaneous management of ruptured pseudoaneurysm of branch of splenic artery and hypersplenism syndrome

Abstract

Pancreatitis induced ruptured pseudoaneurysm (PSA) of the peri-pancreatic and splenic arteries may become a source of life-threatening hemorrhage. Its management is challenging and requires an individualized and multidisciplinary approach. The index case is a 32-year-old chronic alcoholic male presented with multiple episodes of hematemesis and melena. Pathological and imaging findings were consistent with anemia and acute pancreatitis with ruptured PSA of branch of splenic artery, portal cavernoma formation, and splenomegaly. Thrombosis of PSA sac, embolization of offending branch of splenic artery, and splenic infarction were successfully contemplated in a single session by direct percutaneous embolization with gelfoam and glue as embolic agents under guidance of duplex ultrasound imaging. We describe a modified sandwich embolization technique, its long-term success and complications of simultaneous management of ruptured PSA of branch of splenic artery and hypersplenism syndrome in limited resource scenario.

Tratamento endovascular da hemorragia digestiva aguda por volumoso pseudoaneurisma esplênico: relato de caso e revisão da literatura

“…1,11 If it is not treated promptly, the risk of rupture is in the range of 37-47% 12,13 and the mortality rate is 90%. 5,12,13 In the case described here, the patient was admitted because of symptoms related to PASA rupture: upper digestive hemorrhage with hemodynamic instability.…”

“…[13][14][15][16] The most common causes of PASA include local inflammatory states (primarily chronic and acute pancreatitis) and trauma. 4,5,[11][12][13]17 Tessier et al 4 reported associations with pseudocysts in 41% of cases of pancreatic PASA. Among other less frequent causes, Hartman et al 17 described a PASA associated with scleroderma and gastric ulcer, with no history of pancreatitis.…”

“…In both cases, the splenic artery (SA) is the most common site. [4][5][6] Other sites of visceral pseudoaneurysms, in order of frequency, are the hepatic artery and the celiac artery, among others. 4 A pseudoaneurysm cannot be classified as a true aneurysm because it is not surrounded by all three layers of the artery wall -intimal, media, and adventitial.…”

Aneurisma De Tronco Celíaco Na Pancreatite Crônica: Relato De Caso

“…Apesar de o PSAE ser o aneurisma visceral mais comum, ainda assim é uma entidade rara (STICCO, et al, 20016;SCHATZ, et al, 2015). Caso não seja tratado precocemente, apresenta risco de ruptura de 37-47% e taxa de mortalidade de 90% (MANOJ et al, 2015;SAWICKI et al, 2015;FERREIRA et al, 2013). Neste caso, a paciente foi internada pelos sintomas relativos à ruptura do PSAE: hemorragia digestiva alta, cursando com instabilidade hemodinâmica.…”

“…A má digestão, a má absorção de nutrientes, a restrição alimentar em função das dores abdominais e o consumo de álcool são fatores que contribuem para a desnutrição proteico-calórica instalada nesses pacientes. É frequente a presença da subalimentação, associados à diarreia e esteatorreia comprometendo ainda mais no estado nutricional (MANOJ et al, 2015).…”