Left Colic Artery Pseudoaneurysm from Pancreatitis Presenting as Upper Gastrointestinal Hemorrhage

Marichal, Daniel A.; Savage, Clare; Meler, James D.; Kirsch, David; Rees, Chet R.

doi:10.1016/j.jvir.2008.10.006

Cited by 5 publications

(6 citation statements)

References 8 publications

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“…Consequently, there is controversy regarding the ideal timing for aggressive management of these lesions, especially for those that are clinically silent (10,17). Even with evidence in the literature that some visceral pseudoaneurysms occasionally undergo spontaneous thrombosis, the largest drawback of the "wait-and-see" approach is that there is currently no means to predict the advent of pseudoaneurysm rupture (9,(17)(18)(19)(20). For this reason, we support the premise that preventive measures such as endovascular intervention or surgery should be undertaken as soon as the pseudoaneurysm is discovered.…”

Section: Discussionmentioning

confidence: 99%

Endovascular intervention for management of pancreatitis-related bleeding: a retrospective analysis of thirty-seven patients at a single institution

Kim¹,

Shin²,

Yoon³

et al. 2015

Diagn Interv Radiol

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thirty-seven patients underwent endovascular intervention for the management of pancreatitis-related hemorrhage. The underlying etiology of the disease, clinical symptoms and laboratory findings, abnormalities seen on computed tomography, and details regarding the endovascular procedures were assessed, as were the outcome of each procedure and procedure-related complications. RESULTSA total of 41 endovascular procedures were performed in 37 patients. The splenic artery (34.8%) was the most commonly treated artery, and pseudoaneurysm was the most commonly detected abnormality on digital subtraction angiography (78.3%). Transcatheter embolization was performed in the majority of patients (95.1%), while two patients were treated with stent-grafts. Successful hemostasis without rebleeding was achieved in 34 patients (91.9%). Two cases of rebleeding were successfully treated by reintervention. Focal splenic infarction, which developed in eight patients, was either asymptomatic or accompanied by mild, transient fever. Splenic abscess was the only major complication occurring in three patients. Two of these patients died from resulting sepsis, while the third recovered after antibiotic treatment. CONCLUSION Endovascular management is effective for achieving hemostasis in patients with pancreatitis-related bleeding and demonstrates low recurrence and mortality rates.

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Section: Discussionmentioning

confidence: 99%

Endovascular intervention for management of pancreatitis-related bleeding: a retrospective analysis of thirty-seven patients at a single institution

Kim¹,

Shin²,

Yoon³

et al. 2015

Diagn Interv Radiol

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“…There has been no reference to inferior mesenteric sigmoid branch pseudoaneurysm in the literature. One case of traumatic superior rectal artery aneurysm [7] and one case of left colic artery pseudoaneurysm secondary to pancreatitis [8] have been reported, presenting with lower and upper gastrointestinal bleeding, respectively. Both these patients had undergone successful coil embolization.…”

Section: To the Editormentioning

confidence: 99%

Traumatic Pseudoaneurysm of the Inferior Mesenteric Artery Branch: A Rare Cause of Lower GI Bleeding and Treatment with Selective Coil Embolization

Nagarajan

Elango

Laroiya

et al. 2016

Cardiovasc Intervent Radiol

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A forty-five-year-old man presented to emergency services with history of assault on the abdomen by a blunt object. He presented with diffuse abdominal pain and inability to pass stools and flatus. On examination, diffuse abdominal tenderness was present with guarding and rigidity. Emergency plain CT revealed perforation with free air in abdomen. Free air surrounding ileum and sigmoid loops was noted, suggesting the possibility of perforation. Patient was taken for immediate laparotomy in which about 2-2.5 L of hemoperitoneum was present. Sigmoid mesocolon perforation was noted with dusky appearing sigmoid colon. Resection of injured bowel with anastomosis was performed. Two perforations in the ileum were noted approximately 120 cm from the ileocecal junction and about 5 cm of ileum at that region appeared dusky. Resection of around 30 cm of ileum was done and brought out as ileostomy. Two mesenteric tears were noted involving mesentery of ileum, which were closed. He was on elective ventilation for 2 days and extubated. On tenth post-operative day, he developed hematemesis, and it was thought to be due to his alcoholic liver disease and was conservatively managed. Patient was transfused with 4 units of fresh frozen plasma during procedure. Twenty days after the resection and anastomosis, he developed bleeding per rectum of about 500 ml (of both fresh blood with clots). Emergency CECT revealed pseudoaneurysm probably arising from the inferior mesenteric artery branch that probably communicated with the sigmoid colon (Fig. 1A, B). The pseudoaneurysm was located in the region of the sigmoid mesocolon tear. The pseudoaneurysm measured about 2.2 9 2.0 cm. No active extravasation was noted. In this case, recent laparotomy along with poor general condition of the patient meant endovascular intervention was the only option available. Patient was taken up for emergency coil embolization, as another episode of hematochezia might be fatal. Informed written consent for the procedure was taken from the patient and his wife. As it was done as emergency life-saving step, approval from Institutional Review Board was not required. Through left brachial arterial access, the inferior mesenteric artery (IMA) was catheterized using a 4F diagnostic catheter, and diagnostic angiogram was done. The left brachial approach was chosen as femoral approach was unsuccessful in reaching the sigmoid branch as normally inferior mesenteric artery has acute angle take-off from the aorta. Digital Subtraction Angiography (DSA) confirmed a pseudoaneurysm arising from the sigmoid branch of IMA between the left colic and superior rectal branches (Fig. 2A). The pseudoaneurysm measured about 2.2 9 2.0 cm with distal branch continuing toward the sigmoid. There were no branches distal to the pseudoaneurysm. Due to nature of pseudoaneurysm in the setting of acute massive rectal bleeding of more than 500 ml, coil embolization was considered in the proximal artery rather than within the pseudoaneurysmal sac itself. The left colic and marginal artery appeared...

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“…This imaging procedure demonstrated a left colic pseudoaneurysm similar to the source of the IMA pseudoaneurysm in our case, with rupture into the pancreatic duct and active duodenal hemorrhage. The authors opted for coil embolization as the treatment modality [11] . Similarly, Nagarajan et al.…”

Section: Discussionmentioning

confidence: 99%

“…Coils were used in our case, but gel foam slurry, glue, or thrombin are viable options [7 , 14] . Transcatheter embolization is the primary approach for stable patients, considering existing collaterals, but surgical intervention may become necessary [11] . Potential complications include femoral artery pseudoaneurysms, thrombosis, recurrent bleeding, or bowel ischemia/infarction [5] .…”

Section: Discussionmentioning

confidence: 99%

Endovascular management of colic artery pseudoaneurysm: A case report of successful intervention in a 59-year-old male with abdominal hematoma

Khatri,

Parikh,

Smith

et al. 2024

Radiology Case Reports

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Left Colic Artery Pseudoaneurysm from Pancreatitis Presenting as Upper Gastrointestinal Hemorrhage

Cited by 5 publications

References 8 publications

Endovascular intervention for management of pancreatitis-related bleeding: a retrospective analysis of thirty-seven patients at a single institution

Endovascular intervention for management of pancreatitis-related bleeding: a retrospective analysis of thirty-seven patients at a single institution

Traumatic Pseudoaneurysm of the Inferior Mesenteric Artery Branch: A Rare Cause of Lower GI Bleeding and Treatment with Selective Coil Embolization

Endovascular management of colic artery pseudoaneurysm: A case report of successful intervention in a 59-year-old male with abdominal hematoma

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