scholarly journals Pancreatic Pseudocyst with Splenic Artery Erosion, Retroperitoneal and Splenic Hematoma

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Petre V. H. Botianu ◽  
Adrian S. Dobre ◽  
Ana-Maria V. Botianu ◽  
Danusia Onisor
Keyword(s):  
Elevated Level ◽  
Splenic Artery ◽  
Pancreatic Pseudocyst ◽  
Postoperative Morbidity ◽  
Hemodynamic Instability ◽  
Pancreatic Pseudocysts ◽  
Emergency Laparotomy ◽  
Vascular Structures ◽  
Splenic Hematoma

The erosion of the peripancreatic vascular structures is a rare but life-endangering complication of pancreatic diseases. We report a female patient with a multicompartmentalized pancreatic pseudocyst that eroded the splenic artery resulting in a retroperitoneal and splenic hematoma with hemodynamic instability which required emergency laparotomy with splenectomy, partial cystectomy, ligation of the splenic artery at the level of the vascular erosion, cholecystectomy (lithiasis), and multiple drainage. The postoperative course was difficult (elevated level of platelets, pancreatic fistula) but eventually favourable, with no abdominal complaints and no recurrence at 2-year follow-up. The case shows that the pancreatic pseudocysts may present with acute hemorrhagic complications with life-endangering potential and significant postoperative morbidity.

Splenic Artery Pseudoaneurysm Causing Massive Hematemesis 10 Years After Necrotizing Pancreatitis

2020 ◽  
Vol 54 (5) ◽  
pp. 455-457
Author(s):  
Reuben Chen ◽  
Girish Pande ◽  
Mary Ann Johnson
Keyword(s):  
Computed Tomography ◽  
Splenic Artery ◽  
Necrotizing Pancreatitis ◽  
Hemodynamic Instability ◽  
Regional Hospital ◽  
Emergency Laparotomy ◽  
Artery Pseudoaneurysm ◽  
Tertiary Center ◽  
Massive Hematemesis ◽  
Splenic Artery Pseudoaneurysm

We report a case of a 54-year-old male presenting to a regional hospital with severe hematemesis and hemodynamic instability. His medical history was significant for a previous episode of alcoholic necrotizing pancreatitis and pseudocyst, requiring cystoenterostomy drainage and debridement 10 years prior. He underwent multiple gastroscopies and one emergency laparotomy which failed to definitively treat the bleeding. A splenic artery pseudoaneurysm was diagnosed with computed tomography angiography, adjacent to the previous cystoenterostomy site. The patient was transferred to a major tertiary center with access to interventional radiology and underwent successful embolization of the pseudoaneurysm.

Splenic Artery Pseudoaneurysm Rupture into a Pancreatic Pseudocyst with its Subsequent Perforation as the Cause of a Massive Intra-Abdominal Bleeding – Case Report

2016 ◽  
Vol 88 (6) ◽  
Author(s):  
Jerzy Szpakowicz ◽  
Paulina Szpakowicz ◽  
Andrzej Urbanik ◽  
Leszek Markuszewski
Keyword(s):  
Splenic Artery ◽  
Pancreatic Pseudocyst ◽  
Abdominal Cavity ◽  
Pancreatic Pseudocysts ◽  
Cystic Lesions ◽  
Artery Pseudoaneurysm ◽  
Common Cause ◽  
Abdominal Bleeding ◽  
Resection Of The Pancreas ◽  
Splenic Artery Pseudoaneurysm

AbstractPseudocysts account for approximately 70% of all cystic lesions of the pancreas. One of the most dangerous complications of pancreatic pseudocysts is bleeding into the cystic lumen; the most common cause of the bleeding is a splenic artery pseudoaneurysm rupture. This paper presents the case of a 37-year-old man treated surgically for a massive intra–abdominal haemorrhage caused by a splenic artery pseudoaneurysm rupture into the lumen of a tail of pancreas pseudocyst with its subsequent perforation into the abdominal cavity and retroperitoneal space. Peripheral resection of the pancreas together with the cyst and spleen resection was performed. There were no postoperative complications.

scholarly journals Splenic artery pseudoaneurysm as a complication of pancreatic pseudocyst

2011 ◽  
Vol 68 (7) ◽  
pp. 602-606 ◽  
Author(s):  
Sasa Mickovic ◽  
Miroslav Mitrovic ◽  
Nebojsa Stankovic ◽  
Mihailo Bezmarevic ◽  
Milan Jovanovic ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Splenic Artery ◽  
Pancreatic Pseudocyst ◽  
Laboratory Assessment ◽  
Artery Pseudoaneurysm ◽  
Military Medical Academy ◽  
Medical Academy ◽  
One Year ◽  
The Military

Introduction. Pancreatic pseudocyst presented as pseudoaneurysm of the splenic artery is a potential serious complication in patients with chronic pancreatitis. Case report. A 42-year-old male patient with a long-standing evolution of chronic pancreatitis and 8-year long evolution of pancreas pseudocyst was referred to the Military Medical Academy, Belgrade due to worsening of the general condition. At admission, the patient was cachectic, febrile, and had the increased values of amylases in urine and sedimentation (SE). After clinical and diagnostic examination: laboratory assessment, esophagogastroduodenoscopy (EGDS), ultrasonography (US), endoscopic ultrasonography (EUS), multislice computed scanner (MSCT) angiography, pseudoaneurysm was found caused by the conversion of pseudocyst on the basis of chronic pancreatitis. The patient was operated on after founding pancreatic pseudocyst, which caused erosion of the splenic artery and their mutual communication. Postoperative course was duly preceded without complications with one year follow-up. Conclusion. Angiography is the most reliable and the safest method for diagnosing hemorrhagic pseudocysts when they clinically present as pseudoaneurysms. A potentially dangerous complication in the presented case was treated surgically with excellent postoperative results.

scholarly journals Splenic injury following endoscopic drainage of a large pancreatic pseudocyst: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Krittin J. Supapannachart ◽  
Christopher R. Funk ◽  
Lauren M. Gensler ◽  
Matthew P. Butters
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Pancreatic Pseudocyst ◽  
Left Kidney ◽  
Fluid Collection ◽  
Mass Effect ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Left Pleural Effusion ◽  
Splenic Hematoma

Abstract Background Many pancreatic pseudocysts spontaneously resolve, but larger or symptomatic pseudocysts may require procedural management. Though endoscopic ultrasound guided approaches are standard of care and have high success rates, complications can include bleeding, infection, and splenic perforation. This patient case report details an unusual series of complications of endoscopic cystogastrostomy that should encourage clinicians to evaluate for anatomic disruptions caused by mass effects of pancreatic pseudocysts prior to endoscopic pseudocyst drainage. Case presentation A 53-year-old African American male with a past medical history notable for alcohol use disorder, chronic pancreatitis, and insulin dependent diabetes presented with a 4-day history of left upper quadrant abdominal pain. Computed tomography imaging with contrast revealed enlargement of a known pancreatic pseudocyst to 15.9 × 10.4 cm. Due to pseudocyst size and the patient’s symptoms, endoscopic cystogastrostomy stent placement was performed. However, postprocedurally, he developed leukocytosis to 19,800 cells/m3 (from 14,100 cells/m3 preoperatively) as well as acute hypoxemic respiratory failure with a large left pleural effusion. Postprocedural computed tomography with contrast demonstrated a new large subcapsular splenic hematoma in communication with a new subdiaphragmatic fluid collection. Due to suspicion of endoscopic procedural complication, he underwent open laparotomy which revealed grade 4 splenic laceration, septic splenic hematoma, and a subdiaphragmatic abscess. Conclusions While endoscopic drainage of pancreatic pseudocyst was technically successful, this case demonstrates complications from mass effect of a large pancreatic pseudocyst which putatively tore the splenorenal ligament, leading to excessive separation of the left kidney and spleen. If anatomic disruptions caused by mass effect from a pancreatic pseudocyst are recognized through preprocedural abdominal imaging, such cases may be considered for early open repair versus cystogastrostomy.

scholarly journals Endoscopic Drainage of Giant Pancreatic Pseudocysts Using Both Lumen-Apposing Metal Stent and Plastic Stent: A Report of Two Cases and Review of the Current Literature

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Hussam I. A. Alzeerelhouseini ◽  
Muawiyah Elqadi ◽  
Mohammad N. Elqadi ◽  
Sadi A. Abukhalaf ◽  
Hazem A. Ashhab
Keyword(s):  
Pancreatic Pseudocyst ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Metal Stent ◽  
Case Presentation ◽  
Plastic Stent ◽  
History Of ◽  
Giant Pseudocyst ◽  
The Ideal

Introduction. A pancreatic pseudocyst (PP) with major diameter equal to 10 cm or more is called a giant pseudocyst. The ideal management for giant PPs is controversial. Endoscopic drainage is an alternative nonsurgical approach for PP management. Only a few cases of giant PPs were reported to be managed by endoscopic drainage. Case Presentation. We reported two cases of giant PPs following an episode of acute pancreatitis. Both were resolved following endoscopic cystogastrostomy using metallic and double-pigtail stents with excellent outcomes. There was no history of recurrence or complications on follow-up. In addition, we extensively reviewed all available literature studies of giant pancreatic pseudocyst presentation, management, and complications. We summarized all reported cases and presented them in a comprehensive table. Conclusion. The endoscopic cystogastrostomy approach is cost saving, can avoid surgical complications, and offers an early hospital discharge.

scholarly journals Splenic Artery Pseudoaneurysm Masquerading as a Pancreatic Cyst—A Diagnostic Challenge

2015 ◽  
Vol 100 (6) ◽  
pp. 1069-1071 ◽  
Author(s):  
C. Chia ◽  
G. J. Pandya ◽  
A. Kamalesh ◽  
V. G. Shelat
Keyword(s):  
Splenic Artery ◽  
Unusual Case ◽  
Pancreatic Cyst ◽  
Incidental Finding ◽  
Hemodynamic Instability ◽  
Emergency Laparotomy ◽  
Diagnostic Challenge ◽  
Artery Pseudoaneurysm ◽  
Surgical Ligation ◽  
Splenic Artery Pseudoaneurysm

Splenic artery pseudoaneurysm is a rare entity. Clinical diagnosis is challenging because presentation is often varied. It can range from an incidental finding to hemodynamic collapse from sudden rupture and bleeding. The most common cause of this condition is pancreatitis. We report an unusual case of a young man not known to have pancreatitis who presented with hematemesis with normal esophagogastroduodenoscopy. Imaging modalities did not lead to a definitive diagnosis, and he underwent emergency laparotomy with surgical ligation of splenic artery pseudoaneurysm for hemodynamic instability, without a definitive preoperative diagnosis.

Laparoscopic anterior transgastric cystogastrostomy for the treatment of pancreatic pseudocysts

2020 ◽  
Vol 4 (1) ◽  
pp. 006-010
Author(s):  
Yetisir Fahri ◽  
Güzel Kerim
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Procedure ◽  
Pancreatic Pseudocyst ◽  
Medical Condition ◽  
Surgical Approaches ◽  
Pancreatic Pseudocysts ◽  
Surgical Interventions ◽  
Delayed Complications ◽  
Symptoms And Signs

Introduction: Pancreatic pseudocysts (PPs) are mostly delayed complications of acute or chronic pancreatitis and trauma. Pancreatic pseudocysts are usually managed by supportive medical treatment without surgical procedure. All the surgical interventions (percutaneous, endoscopic or surgical approaches) are based on the location, size, symptoms, complications of the pancreatic pseudocyst and medical condition of the patients. Recently, laparoscopic cystogastrostomy has become most appropriate approach especially for retrogastric pancreatic pseudocysts. In this study, we would like to report results of laparoscopic anterior transgastric cystogastrostomy by using linear articulated endo GIA stapler (Covidien medium thick purple) and versa-lifter (versa lifter®, laparoscopic retractor, manufactured by protomedlabs, France) in 14 pancreatic pseudocysts patients. Methods: We retrospectively analyzed data of patients with pancreatic pseudocysts treated by laparoscopic anterior transgastric cystogastrostomy from September 2010 to October 2014. All of the patients were controlled for the recurrence of pancreatic pseudocysts in February 2017. Results: 14 patients with pancreatic pseudocysts were managed by laparoscopic anterior transgastric cysto-gastrostomy. Conversion was performed in only one patient (7%). There were no symptoms and signs of recurrence of pancreatic pseudocyst during on average 43.6 months follow up time. Conclusion: Laparoscopic cystogastrostomy by using articulated linear endo-GIA stapler and versa-lifter is a safe and effective method for management of appropriate retro-gastric pancreatic pseudocysts.

scholarly journals Mediastinal Extension of a Pancreatic Pseudocyst: A Rare Intrathoracic Complication of Pancreatitis

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Carol Vitellas ◽  
Ivo Besong Mangeb ◽  
Luis Regalado ◽  
Chiemezie Chianotu Amadi
Keyword(s):  
Pancreatic Pseudocyst ◽  
Fluid Collection ◽  
Nutrition Therapy ◽  
Posterior Mediastinum ◽  
Pancreatic Pseudocysts ◽  
Esophageal Hiatus ◽  
Atypical Chest Pain ◽  
Serum Lipase ◽  
Mediastinal Extension

Pancreatic pseudocysts are a common complication of pancreatitis. However, mediastinal extension of a pseudocyst is rare and often presents with atypical symptoms. We present a case of mediastinal extension of a pancreatic pseudocyst in a 56-year-old woman with a history of alcohol-related chronic pancreatitis, who presented with acute on chronic epigastric abdominal pain and atypical chest pain. Serum lipase was elevated, and imaging by contrast-enhanced computed tomography (CT) demonstrated a paraesophageal fluid collection. This collection was continuous with a peripancreatic pseudocyst and extended into the posterior mediastinum via the esophageal hiatus. Mediastinal extension of a pancreatic pseudocyst was confirmed by magnetic resonance imaging (MRI). The patient was managed conservatively in the hospital with parenteral nutrition therapy, pain control, and close imaging observation. The patient was discharged home to continue conservative management and close imaging follow-up. An initial follow-up CT examination 8 weeks after discharge revealed interval decrease in the posterior mediastinal collection but also interval development of loculated left pleural and pericardial effusions.

scholarly journals Pancreatic Pseudocysts Transpapillary and Transmural Drainage

HPB Surgery ◽  
2000 ◽  
Vol 11 (5) ◽  
pp. 333-338 ◽  
Author(s):  
E. Della Libera ◽  
E. S. Siqueira ◽  
M. Morais ◽  
M. R. S. Rohr ◽  
C. Q. Brant ◽  
...  
Keyword(s):  
Pancreatic Pseudocyst ◽  
Pain Scale ◽  
Pancreatic Pseudocysts ◽  
Endoscopic Drainage ◽  
Intention To Treat ◽  
Persistent Abdominal Pain ◽  
Serial Ct ◽  
Transmural Drainage ◽  
Good Treatment Option

Background: Pancreatic pseudocyst endoscopic drainage has been described as a good treatment option, with morbidity and mortality rates that are lower than surgery. The aim of our study is to describe the efficacy of different forms of endoscopic drainage and estimate pseudocyst recurrence rate after short follow up period.Patients and Methods: We studied 30 patients with pancreatic pseudocyst that presented some indication for treatment: persistent abdominal pain, infection or cholestasis. Clinical evaluation was performed with a pain scale, 0 meaning absence of pain and 4 meaning continuous pain. Pseudocysts were first evaluated by abdominal CT scan, and after endoscopic retrograde pancreatography the patients were treated by transpapillary or transmural (cystduodenostomy or cystgastrostomy) drainage. Pseudocyst resolution was documented by serial CT scans.Results: 25/30 patients could be treated. Drainage was successful in 21 (70% in an ‘intention to treat’ basis). After a mean follow-up of 42±35.82 weeks, there was only 1 (4.2%) recurrence. A total of 6 complications occurred in 37 procedures (16.2%), and all but 2 were managed clinically and/or endoscopically: there was no mortality related to the procedure. Patients submitted to combined drainage needed more procedures than the other groups. There was no difference in the efficacy when we compared the three different drainage methods.Conclusions: We concluded that pancreatic pseudocyst endoscopic drainage is possible in most patients, with high success rate and low morbidity.

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