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Erschienen in: Journal of General Internal Medicine 3/2011

01.03.2011 | Clinical Practice: Clinical Images

Splenic Artery Pseudoaneurysm Complicating Pancreatitis

verfasst von: Mehul Parikh, MD, Ankit Shah, BA, Abdul Abdellatif, MD

Erschienen in: Journal of General Internal Medicine | Ausgabe 3/2011

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Excerpt

A 62-year-old man with alcoholic cirrhosis was admitted for acute on chronic pancreatitis. During his last admission 3 months before, a CT scan had showed ascites as well as a 5.0-cm high-density posterior pancreatic tail fluid collection communicating with high-density material between the aorta and left renal vein (Fig. 1). The patient refused further workup and was discharged home. During this next admission, CT angiography showed an 8.6-cm partially thrombosed splenic artery pseudoaneurysm at the pancreatic tail and a subcapsular splenic fluid collection (Fig. 2). While awaiting intervention, the patient suddenly became pale and hypotensive. He died from a ruptured pseudoaneurysm leading to hemorrhage and acute hemodynamic collapse. Splenic artery pseudoaneurysm is a rare complication of pancreatitis and pancreatic pseudocysts. Other etiologies include peptic ulcer disease, trauma, and complications of surgical exploration. Release of pancreatic enzymes results in autodigestion of the vessel wall. Risk of rupture can be as high as 37%, with a mortality rate approaching 90% when untreated1. Early diagnosis and urgent treatment are imperative regardless of size or symptoms. Pseudoaneurysms may be mistaken for pseudocysts or other peripancreatic fluid collections on CT scan. High density within peripancreatic fluid collections should raise the suspicion of blood. Angiography offers a definitive diagnosis. Treatment options include transcatheter embolization, splenectomy with or without distal pancreatectomy, or splenic artery ligation alone. In our case, the patient likely had a pseudocyst with a concomitant bleeding pseudoaneurysm. The pseudoaneurysm progressed in size and led to fatal rupture.
Literatur
1.
Zurück zum Zitat Agarwal G, Johnson P, Fishman E. Splenic artery aneurysms and pseudoaneurysms: clinical distinctions and CT appearances. Am J Roentgenol. 2007;188(4):992–9.CrossRef Agarwal G, Johnson P, Fishman E. Splenic artery aneurysms and pseudoaneurysms: clinical distinctions and CT appearances. Am J Roentgenol. 2007;188(4):992–9.CrossRef
Metadaten
Titel
Splenic Artery Pseudoaneurysm Complicating Pancreatitis
verfasst von
Mehul Parikh, MD
Ankit Shah, BA
Abdul Abdellatif, MD
Publikationsdatum
01.03.2011
Verlag
Springer-Verlag
Erschienen in
Journal of General Internal Medicine / Ausgabe 3/2011
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-010-1538-z

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