1. PANCREATIC PSEUDOANEURYSM.
- Author
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Musa, Adelina Mihaela, Musa, Mihai, Tieranu, Cristian George, Olteanu, Andrei, and Saftoiu, Adrian
- Subjects
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GASTROINTESTINAL hemorrhage , *FALSE aneurysms , *SPLENIC artery , *PANCREATIC duct , *PANCREATIC enzymes , *ALIMENTARY canal , *CHRONIC pancreatitis - Abstract
Historic. A 59-year-old patient, a chronic ethanol user, without any medical history, presents with hematemesis and abdominal pain. Methods. The level of hemoglobin was 8.2 g/dL, without any other biological modification. The emergency upper digestive endoscopy revealed a large clot that almost completely occupied the esophageal and gastric lumen, up to the duodenal angle. Endoscopic re-evaluation at 24 hours: esophagus and stomach with free lumen, gastric body with extrinsic compression on the posterior face towards the greater curvature and intensely edematous mucosa at that level. Abdominal ultrasound revealed multiple calcifications at the level of the pancreatic head and body and at the level of the tail of the pancreas, a cystic formation of approximately 5 cm was visualized, with a pulsed Doppler signal. CEUS:hyperinhancement in the center of the lesion and lack of contrast in the periphery, an aspect that was maintained in the portal and parenchymal phases. The abdominal CT showed a corporeo-caudal pancreatic pseudoaneurysm of the splenic artery with dimensions of 65 mm, with parietal thrombosis with a stratified appearance, affecting about 40% of the lumen, with contrast extravasation, in direct contact with the posterior gastric wall. Results. The suspicion of upper digestive hemorrhage secondary to a fistula between the pseudo-aneurysm of the splenic artery and the stomach was raised, but also the possibility of a wirsungorrhagia, given the direct contact of the lesion with the pancreatic tail. Abdominal angiography with angioplasty was performed, secondary to the extravasation of the contrast substance at the level of the splenic artery with a 3/18 mm Bentley type stent graft, with an optimal result, without extravasation of contrast. Diagnosis. Upper gastrointestinal hemorrhage secondary to a splenic artery pseudoaneurysm. Chronic ethanolic pancreatitis. Conclusions. Bleeding from splenic artery pseudoaneurysm is a rare and often fatal cause of gastrointestinal bleeding The most common causes are pancreatitis and abdominal trauma. In pancreatitis, pancreatic enzymes can cause vascular necrosis and rupture of elastic tissue, leading to pseudoaneurysm formation. Another way can be through pseudocysts (41% of patients with pseudoaneurysms), In this patient's case, the pseudoaneurysm most likely occurred secondary to a pseudocyst that eroded the splenic artery, with intracystic hemorrhage, which led to a localized hemorrhage and not to a hemoperitoneum, and subsequently to the digestive tract, transgastric or through the main pancreatic duct. After stent placement by angiography, the patient had a favorable evolution at ultrasound reevaluation at 1 month, with remission of the lesion. [ABSTRACT FROM AUTHOR]
- Published
- 2023