Giant Celiac Artery Pseudoaneurysm in a Case of Chronic Pancreatitis: A Rare Case Report With Literature Review

Abstract

Pancreatic pseudoaneurysms though uncommon can result in life-threatening spontaneous acute gastrointestinal or intraperitoneal hemorrhage. Celiac artery pseudoaneurysm in a background of chronic pancreatitis is a very rare event. Digital Subtraction Angiography is an important adjunct in the diagnosis and follow-up with the advantage of providing therapeutic options along with giving other details regarding the site, size, and flow characteristics. It has replaced emergency surgical procedures with the added advantage of fewer postoperative complications and lower morbidity and mortality. An urgent surgical intervention remains the only option when such endovascular management fails, not feasible, or is unavailable. Surgical options include proximal arterial ligation or a pancreatic resection, depending on the location of the pseudoaneurysm. We report a case of a 35-year-old gentleman, a known patient of chronic pancreatitis, who presented to our emergency with clinical features of hypovolemic shock and was diagnosed to have celiac artery pseudoaneurysm. Following a failed endovascular coiling, he was successfully managed with operative celiac artery ligation.

Large gastroduodenal artery pseudoaneurysm, arterioportal fistula and portal vein stenosis in chronic pancreatitis treated using combined transarterial embolization and transportal stenting: A case report

“…In pancreatitis, pseudoaneurysm is caused by erosion of nearby vessels due to digestive enzyme leakage. [ 1 ] As mentioned earlier, it is most common in the splenic artery and relatively rare in the GDA.…”

“…Visceral artery pseudoaneurysms are relatively rare complications of chronic pancreatitis. [ 1 ] The reported incidence of pseudoaneurysm formation from pancreatitis varies from 1.3% to 10% among different case series. [ 2 ] Nevertheless, chronic pancreatitis is one of the most common causes of such pseudoaneurysm.…”

“…[ 3 ] with the splenic artery being the most frequently involved (50%), followed by the gastroduodenal (10%–15%), pancreaticoduodenal, superior mesenteric, left gastric, and celiac arteries. [ 1 , 3 ] Arterioportal fistula (APF) is a rare vascular disorder of the abdominal viscera. They are arteriovenous communications between the splanchnic arteries and portal vein or its tributaries.…”

Mycotic Pseudoaneurysm of Thoracic Aortic Caused by Salmonella Paratyphi A: A Case Report

“…The gold standard management strategy remains surgical resection and debridement of the infected aorta and the surrounding tissues followed by long-term antibiotic therapy. Traditional surgical methods generally require arterial repair, 13 , 14 vascular ligation, 15 vascular anastomosis, vascular transplantation, 7 , 16 and pseudoaneurysm resection. However, traditional surgery has some disadvantages, including substantial surgical trauma, difficult technique, long procedure time, and several complications.…”