Rupture of splenic artery pseudoaneurysm presenting with massive upper gastrointestinal bleed

Balsarkar, Dharmesh J.; Joshi, Mohan

doi:10.1016/s0002-9610(01)00872-8

Cited by 17 publications

(6 citation statements)

References 5 publications

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“…Pseudoaneurysm originating from the SPA is well described as a complication of pancreatitis,27,28 but this is an unusual source of bleeding after pancreatobiliary surgery. Selective TAE is indicated because ischemia of the spleen is rare.…”

Section: Discussionmentioning

confidence: 99%

Management of Massive Arterial Hemorrhage After Pancreatobiliary Surgery: Does Embolotherapy Contribute to Successful Outcome?

Fujii

Shimada

Endo

et al. 2007

Journal of Gastrointestinal Surgery

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Massive arterial hemorrhage is, although unusual, a life-threatening complication of major pancreatobiliary surgery. Records of 351 patients who underwent major surgery for malignant pancreatobiliary disease were reviewed in this series. Thirteen patients (3.7%) experienced massive hemorrhage after surgery. Complete hemostasis by transcatheter arterial embolization (TAE) or re-laparotomy was achieved in five patients and one patient, respectively. However, 7 of 13 cases ended in fatality, which is a 54% mortality rate. Among six survivors, one underwent selective TAE for a pseudoaneurysm of the right hepatic artery (RHA). Three patients underwent TAE proximal to the proper hepatic artery (PHA): hepatic inflow was maintained by successful TAE of the gastroduodenal artery in two and via a well-developed subphrenic artery in one. One patient had TAE of the celiac axis for a pseudoaneurysm of the splenic artery (SPA), and hepatic inflow was maintained by the arcades around the pancreatic head. One patient who experienced a pseudoaneurysm of the RHA after left hemihepatectomy successfully underwent re-laparotomy, ligation of RHA, and creation of an ileocolic arterioportal shunt. In contrast, four of seven patients with fatal outcomes experienced hepatic infarction following TAE proximal to the PHA or injury of the common hepatic artery during angiography. One patient who underwent a major hepatectomy for hilar bile duct cancer had a recurrent hemorrhage after TAE of the gastroduodenal artery and experienced hepatic failure. In the two patients with a pseudoaneurysm of the SPA or the superior mesenteric artery, an emergency relaparotomy was required to obtain hemostasis because of worsening clinical status. Selective TAE distal to PHA or in the SPA is usually successful. TAE proximal to PHA must be restricted to cases where collateral hepatic blood flow exists. Otherwise or for a pseudoaneurysm of the superior mesenteric artery, endovascular stenting, temporary creation of an ileocolic arterioportal shunt, or vascular reconstruction by re-laparotomy is an alternative.

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Section: Discussionmentioning

confidence: 99%

Management of Massive Arterial Hemorrhage After Pancreatobiliary Surgery: Does Embolotherapy Contribute to Successful Outcome?

Fujii

Shimada

Endo

et al. 2007

Journal of Gastrointestinal Surgery

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“…The pathogenetic mechanism is secondary to degradation of the vessel wall by pancreatic enzymes released from a destroyed pancreatic duct, resulting in a primary formation of a pseudoaneurysm or rupture of the vessel into a preexisting pseudocyst, which then converts into a pseudoaneurysm 2. Pseudoaneurysms usually present symptoms such as gastrointestinal bleeding (60%), abdominal pain (50%), and splenomegaly or pulsatile abdominal tumors (<5%) 11. In our case, the patient reported abdominal pain without gastrointestinal bleeding; therefore, the pain was more likely associated with his initial pancreatitis process, rather than with the pseudoaneurysm itself.…”

Section: Discussionmentioning

confidence: 61%

Spontaneous regression of splenic artery pseudoaneurysm: a rare complication of acute pancreatitis

Castillo-Tandazo

Ortega²,

Mariscal³

2013

IMCRJ

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Spontaneous pseudoaneurysm regression is a rare event. In particular, the spontaneous regression of a splenic artery pseudoaneurysm has, to our knowledge, been previously documented in only two case reports. Furthermore, the pathophysiological mechanism of this event remains unclear. However, it is fully known that this vascular complication is potentially life-threatening and presents a high mortality rate if untreated. We report the case of a 49-year-old man affected by acute pancreatitis. Computed tomography was performed, and showed a pseudoaneurysm of the splenic artery. This patient underwent endoscopic retrograde cholangiopancreatography to treat the pancreatitis, while the vascular complication was managed with a careful and conservative treatment. On day 6 of hospitalization, a second computed tomography scan was performed and revealed complete regression of the pseudoaneurysm. This case describes the diagnosis and management of splenic artery pseudoaneurysm following acute pancreatitis and its spontaneous regression.

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“…Significant challenges still remain for the diagnosis and treatment of GI bleeding secondary to rare conditions such as hemosuccus pancreaticus or ruptured pseudoaneurysm. A number of case reports have reported such situations, which are most commonly seen in patients having AP in combination with the rupture of pseudoaneurysms of the splenic or hepatic artery into the pancreatic duct that is confirmed by selective celiac angiography. Severe gastroduodenal necrosis with perforation has rarely been reported .…”

Section: Discussionmentioning

confidence: 95%

Prevalence and risk factors for clinically significant upper gastrointestinal bleeding in patients with severe acute pancreatitis

Zhan

Guo

Yang

et al. 2015

J of Digest Diseases

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Rupture of splenic artery pseudoaneurysm presenting with massive upper gastrointestinal bleed

Cited by 17 publications

References 5 publications

Management of Massive Arterial Hemorrhage After Pancreatobiliary Surgery: Does Embolotherapy Contribute to Successful Outcome?

Management of Massive Arterial Hemorrhage After Pancreatobiliary Surgery: Does Embolotherapy Contribute to Successful Outcome?

Spontaneous regression of splenic artery pseudoaneurysm: a rare complication of acute pancreatitis

Prevalence and risk factors for clinically significant upper gastrointestinal bleeding in patients with severe acute pancreatitis

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