P-P56 Successful endovascular embolisation of a recurrent gastroduodenal artery aneurysm in a patient presenting with acute on chronic pancreatitis

Abstract Background Pseudoaneurysms are recognised to be a serious complication of chronic pancreatitis. Visceral artery aneurysms (VAA) can be difficult to determine and most commonly occur in the splenic or hepatic artery. Gastroduodenal artery pseudoaneurysms (GDA) have been reported to be the most common VAA following pancreatic surgery. We aim to outline the successful management of a patient with a recurrent 5.5cm GDA pseudoaneurysm following previous embolisation 2 years prior. Methods The 59yr old patient had a history of alcohol related necrotic pancreatitis with pseudocyst formation requiring percutaneous drainage in 2019. This was complicated by pseudoaneurysm formation requiring embolisation of the inferior pancreatico-duodenal artery and GDA. In April 2021 they were readmitted with recurrent abdominal pain thought to be secondary to chronic pancreatitis and one episode of haematemesis. Results Endoscopy revealed inflammation of D1 with signs of recent mucosal bleeding with a recent abdominal ultrasound showing a 4.7x4.6cm apparent pseudocyst. A CT pancreas was performed to assess the pseudocyst however an incidental pseudoaneurysm at the pancreatic head with a sac measuring 5.5cm in diameter and contrast material measuring 3cm in diameter was present. Peripancreatic and retroperitoneal inflammation indicative of acute on chronic pancreatitis. The patient underwent embolisation of the recurrent GDA pseudoaneurysm successfully with no more filling of the previously seen pseudoaneurysm and was safely discharged. Conclusions Recurrent GDA pseudoaneurysms are a very rare complication of recurrent pancreatitis, however should be considered in patients presenting severe epigastric pain with a history of previous pseudoaneurysms.

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Visceral artery aneurysm: an unusual cause of abdominal pain

BMJ Case Reports ◽

10.1136/bcr-2020-238019 ◽

2020 ◽

Vol 13 (12) ◽

pp. e238019

Author(s):

Maha Al Baghdadi ◽

Parekha Yedla

Keyword(s):

Abdominal Pain ◽

Multiorgan Failure ◽

Artery Aneurysm ◽

Gastroduodenal Artery ◽

Visceral Artery ◽

Caucasian Woman ◽

Visceral Artery Aneurysm ◽

Visceral Artery Aneurysms

Visceral artery aneurysms (VAAs) are uncommon with an approximate incidence of 0.01%–0.2%. Gastroduodenal artery (GDA) aneurysm is a rare subtype of these uncommon visceral aneurysms that can be fatal if ruptured. We present a case of a 58-year-old Caucasian woman with a VAA and a large haematoma arising from an actively bleeding GDA. While patients with VAA may remain asymptomatic, with some of the aneurysms found incidentally during imaging, they may also present with abdominal pain, anaemia and possible multiorgan failure which may be fatal.

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Concurrent Treatment of Acute Pancreatitis and Multiple Visceral Artery Aneurysms Using Endovascular Techniques

Vascular and Endovascular Surgery ◽

10.1177/1538574412440509 ◽

2012 ◽

Vol 46 (3) ◽

pp. 283-286 ◽

Cited By ~ 1

Author(s):

Mario Mitkov ◽

Weesam Kassim Al-Khatib ◽

Wei Zhou

Keyword(s):

Acute Pancreatitis ◽

Surgical Techniques ◽

Artery Aneurysm ◽

Celiac Artery ◽

Gastroduodenal Artery ◽

Visceral Artery ◽

Endovascular Techniques ◽

Concurrent Treatment ◽

Visceral Artery Aneurysms ◽

Celiac Artery Aneurysm

Multiple aneurysms involving the celiac axis are extremely rare. Celiac artery aneurysms account for only 4% of all visceral aneurysms with 40% having concomitant aneurysms such as gastroduodenal artery (GDA) aneurysms. Development of a GDA aneurysm is associated with pancreatitis. If a GDA aneurysm ruptures, traditional repair is through open surgical techniques with significant morbidity and mortality as up to 50% occur in the setting of chronic pancreatitis. However, a ruptured GDA aneurysm causing pancreatitis has not been described previously. We report a case of successful endovascular treatment of a ruptured GDA aneurysm and concomitant celiac artery aneurysm leading to the resolution of acute pancreatitis.

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Endovascular treatment of wide-neck saccular renal artery aneurysm with waffle-cone technique

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.200116 ◽

2021 ◽

Vol 20 ◽

Author(s):

Paulo Eduardo Ocke Reis ◽

Guilherme de Palma Abrão ◽

Leonardo Roever

Keyword(s):

Endovascular Procedures ◽

Imaging Techniques ◽

Artery Aneurysm ◽

Visceral Artery ◽

Endovascular Management ◽

Endovascular Techniques ◽

The Past ◽

Visceral Artery Aneurysms ◽

History Of ◽

Wide Neck

Abstract In the past, treatment of visceral artery aneurysms (VAAs) was exclusively surgical. These aneurysms were rarely diagnosed in elective or emergency cases. Development of imaging techniques and endovascular procedures has changed the history of the therapeutic options for this pathology. Endovascular management of VAAs has arisen to advances in endovascular techniques and has achieved high efficacy.

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The Aftermath of a Hepatic Artery Aneurysm—A Rare Etiology of Biliary Obstruction!

Clinical Medicine Insights Gastroenterology ◽

10.1177/1179552217711430 ◽

2017 ◽

Vol 10 ◽

pp. 117955221771143 ◽

Cited By ~ 1

Author(s):

Catherine Linzay ◽

Abhishek Seth ◽

Kunal Suryawala ◽

Ankur Sheth ◽

Moheb Boktor ◽

...

Keyword(s):

Obstructive Jaundice ◽

Hepatic Artery ◽

Significant Risk ◽

Artery Aneurysm ◽

Biliary Tree ◽

Visceral Artery ◽

Biliary Stenting ◽

Hepatic Artery Aneurysm ◽

Skin Imaging ◽

Visceral Artery Aneurysms

Background: Hepatic artery aneurysms (HAAs) constitute 14% to 20% of visceral artery aneurysms. Most HAAs are asymptomatic. Although rare, obstructive jaundice due to external bile duct compression or rupture of the HAA into the biliary tree with occlusion of the lumen from blood clots has been reported. Case presentation: A 56-year-old white man presented to an outside hospital with symptoms of obstructive jaundice, including abdominal pain and yellowing of the skin. Imaging showed a large HAA. Patient was transferred to our hospital where an endoscopic retrograde cholangiopancreatography with biliary stenting was performed. This was followed by coil embolization of the HAA with improvement in symptoms and liver chemistries. Conclusions: Most clinicians agree that management of HAA is highly variable and depends on clinical presentation and anatomic location. Biliary stenting provides temporary relief for patients with obstructive jaundice. Definitive options include open aneurysmal repair versus endovascular therapy. Hepatic artery aneurysms represent a significant risk for hemorrhage and therefore must be addressed promptly once discovered.

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Current management strategies for visceral artery aneurysms: an overview

Surgery Today ◽

10.1007/s00595-019-01898-3 ◽

2019 ◽

Vol 50 (1) ◽

pp. 38-49 ◽

Cited By ~ 8

Author(s):

Hideaki Obara ◽

Matsubara Kentaro ◽

Masanori Inoue ◽

Yuko Kitagawa

Keyword(s):

Mesenteric Artery ◽

Management Strategies ◽

Hybrid Approach ◽

Celiac Artery ◽

Visceral Artery ◽

Anatomical Location ◽

Current Management ◽

Risk Of Rupture ◽

Visceral Artery Aneurysms ◽

History Of

Abstract Visceral artery aneurysms (VAAs) are rare and affect the celiac artery, superior mesenteric artery, and inferior mesenteric artery, and their branches. The natural history of VAAs is not well understood as they are often asymptomatic and found incidentally; however, they carry a risk of rupture that can result in death from hemorrhage in the peritoneal cavity, retroperitoneal space, or gastrointestinal tract. Recent advances in imaging technology and its availability allow us to diagnose all types of VAA. VAAs can be treated by open surgery, laparoscopic surgery, endovascular therapy, or a hybrid approach. However, there are still no specific indications for the treatment of VAAs, and the best strategy depends on the anatomical location of the aneurysm as well as the clinical presentation of the patient. This article reviews the literature on the etiology, clinical features, diagnosis, and anatomic characteristics of each type of VAA and discusses the current options for their treatment and management.

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Diagnostic Pitfalls and Therapeutic Strategies in the Treatment of Pancreatic Duct Haemorrhage

HPB Surgery ◽

10.1155/1997/96068 ◽

1997 ◽

Vol 10 (5) ◽

pp. 293-297 ◽

Cited By ~ 2

Author(s):

P. J. Gallagher ◽

G. Mclauchlin ◽

P. C. Bornman ◽

J. E. J. Krige ◽

J. Thomson ◽

...

Keyword(s):

Alcohol Abuse ◽

Pancreatic Duct ◽

Distal Pancreatectomy ◽

Splenic Artery ◽

Epigastric Pain ◽

Gastroduodenal Artery ◽

Diagnostic Dilemma ◽

Artery Ligation ◽

Men 2 ◽

History Of

Haemorrhage via the pancreatic duct, a rare cause of upper gastrointestinal bleeding (GIB), often poses a diagnostic dilemma. We analysed our experience with 10 patients (8 men, 2 women; mean age 44 years, range 34 – 62) treated during a 12 year period. All had a history of alcohol abuse and presented with major upper GIB requiring a median of 8 units (range 2 – 40) blood, transfusion. Nine had upper abdominal pain at the time of admission and nine had a history of pancreatitis. Upper gastroduodenal endoscopy (median 4; range 1 – 9), was diagnostic in only one. Side-viewing endoscopy showed bleeding from the pancreatic duct in 7 of 8 patients. Visceral aneurysms were demonstrated in 7 of 9 patients in whom coeliac angiography was carried out: (splenic artery 4, gastroduodenal artery 2, and pancreaticoduodenal artery 1). Two of 4 selective embolisations were successful. Six patients underwent distal pancreatectomy, 1 had gastroduodenal artery ligation and 1 died of coagulopathy following a total pancreatectomy. Pancreatic duct haemorrhage should be considered in patients with unexplained recurrent upper GIB, alcohol abuse and epigastric pain, particularly in those with established chronic pancreatitis. Selective angiography is essential for diagnosis and management. For bleeding sites in the head of the pancreas, embolisation should be attempted to avoid major resection. Distal pancreatectomy is preferred for splenic artery lesions.

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Gastrointestinal Hemorrhage Due to Splenic Artery Aneurysm Pancreatic Duct Fistula in Chronic Pancreatitis

HPB Surgery ◽

10.1155/1993/81291 ◽

1993 ◽

Vol 7 (2) ◽

pp. 149-155 ◽

Cited By ~ 4

Author(s):

Christian Seiler ◽

Leslie H. Blumgart

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Gastrointestinal Hemorrhage ◽

Splenic Artery ◽

Epigastric Pain ◽

Rare Complication ◽

Artery Aneurysm ◽

Splenic Artery Aneurysm ◽

Life Threatening ◽

Threatening Situation

Gastrointestinal hemorrhage due to splenic artery aneurysm pancreatic duct fistula in chronic pancreatitis is rare. It is, however, important to diagnose this condition particularly in patients having chronic pancreatitis, since it may result in a life-threatening situation. The diagnosis is usually difficult to establish and it may take repeated admissions for intermittent gastrointestinal bleeding until the real source is recognized. Clinical attacks of epigastric pain followed by GI-bleeding 30–40 minutes later are characteristic. Occasionally these attacks are followed by transient jaundice. The present case report describes this rare complication and reviews the current literature.

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Pseudoaneurysm of the Inferior Pancreaticoduodenal Artery Due to Cholecystitis

Reports ◽

10.3390/reports2010011 ◽

2019 ◽

Vol 2 (1) ◽

pp. 11 ◽

Cited By ~ 1

Author(s):

Jayan George ◽

Samuel Besant ◽

Trevor Cleveland ◽

Ahmed Al-Mukhtar

Keyword(s):

Acute Kidney Injury ◽

Conservative Treatment ◽

Epigastric Pain ◽

Kidney Injury ◽

Visceral Artery ◽

Intravenous Fluids ◽

Rare Occurrence ◽

Pancreaticoduodenal Artery ◽

Tertiary Centre ◽

Visceral Artery Aneurysms

Inferior pancreaticoduodenal artery pseudoaneurysms and aneurysms are a rare occurrence, comprising of approximately 10% of visceral artery aneurysms and pseudoaneurysms. The cause is normally due to trauma, iatrogenic or pancreatitis. We present a case of a patient re-presenting to hospital following treatment of acute cholecystitis with epigastric pain, dysphagia, pyrexia, nausea, vomiting and an acute kidney injury. Following cholecystostomy, intravenous fluids and conservative treatment for her symptoms, she failed to improve significantly and was found to have a 6 mm pseudoaneurysm of the inferior pancreaticoduodenal artery on day twenty of her admission. She was transferred to a tertiary centre and was treated with an embolisation and recovered well from the procedure.

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