Ischaemic pancreatitis and pseudocyst: a rare complication of embolization of gastroduodenal artery aneurysm

Abstract

A 72-year-old Caucasian man was transferred from Trangie Hospital with 7 h history of generalized abdominal pain. It was associated with hypotension. There was no history of fever, vomiting, change in bowel habit or weight loss. He has history of type 2 diabetes mellitus, hypertension, atrial fibrillation (AF), obstructive sleep apnoea and ischaemic heart disease. He is on warfarin for AF. He lives with his wife in Trangie independently. He is an occasional drinker and ex-smoker.On examination, he was afebrile, blood pressure was 70 mmHg systolic and heart rate was 100/min. Abdomen was soft and palpable mass in right lower quadrant was identified. He was taken straight to computed tomography (CT) after resuscitation. CT abdomen and pelvis showed a large (>20 cm) haematoma in the right of the abdomen, with active bleeding in the region of the gastroduodenal artery (GDA). An aneurysm is seen in the superior margin of the collection (Fig. 1).His blood tests showed haemoglobin was 81, white cell count was 13.5 and international normalized ratio was 4.5. He was found to have metabolic acidosis with pH of 7.18 and lactate of 6.5. He was given 2 units each of packed red blood cells and fresh frozen plasma, Fig. 3. Cross-sectional CT showing pancreatic pseudocyst.

Acute ischemic pancreatitis: A rare complication of empirical gastroduodenal artery embolization

“…A literature search yielded four cases of acute pancreatitis reported after TAE for refractory UGIB. [ 11 12 13 14 ] Coils ± gelfoam were used as the embolic agents in all four cases with embolization of “front and back door” supply as per conventional principles. The patients presented with symptoms of pancreatitis of 12 hours to 70 days duration (mean = 29 days) post GDA embolization.…”

Rupture of an Idiopathic Aneurysm of the Inferior Pancreaticoduodenal Artery Leading to an Intra-Abdominal Bleeding

“…Although it's not a distinct cause of pancreatitis, a few cases of ischemic pancreatitis have been reported after embolization of gastroduodenal artery aneurysm [10].…”

Repercussões da ligadura da artéria gastroduodenal do receptor no fluxo sanguíneo arterial do enxerto e na perfusão dos ductos biliares durante o transplante hepático

“…Mais recentemente, alguns autores a recomendam por razões técnicas, como a obtenção de uma artéria hepática mais curta para anastomose e evitar redundância 59 . Por outro lado, alguns autores evitam a ligadura da AGD devido à preocupação com a diminuição da vascularização da porção distal da árvore biliar do receptor e com possível pancreatite aguda pós-operatória [65][66][67] A contribuição da AGD do receptor para o fluxo arterial do enxerto é discutível na comunidade transplantadora. No entanto, existem algumas evidências da influência da AGD no fluxo sanguíneo da artéria hepática quando analisamos casos de síndrome não-oclusiva de hipoperfusão da artéria hepática causada pela AGD.…”