Giant Celiac Artery Pseudoaneurysm in a Case of Chronic Pancreatitis: A Rare Case Report With Literature Review

Pancreatic pseudoaneurysms though uncommon can result in life-threatening spontaneous acute gastrointestinal or intraperitoneal hemorrhage. Celiac artery pseudoaneurysm in a background of chronic pancreatitis is a very rare event. Digital Subtraction Angiography is an important adjunct in the diagnosis and follow-up with the advantage of providing therapeutic options along with giving other details regarding the site, size, and flow characteristics. It has replaced emergency surgical procedures with the added advantage of fewer postoperative complications and lower morbidity and mortality. An urgent surgical intervention remains the only option when such endovascular management fails, not feasible, or is unavailable. Surgical options include proximal arterial ligation or a pancreatic resection, depending on the location of the pseudoaneurysm. We report a case of a 35-year-old gentleman, a known patient of chronic pancreatitis, who presented to our emergency with clinical features of hypovolemic shock and was diagnosed to have celiac artery pseudoaneurysm. Following a failed endovascular coiling, he was successfully managed with operative celiac artery ligation.

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Successful Embolization of Posterior Inferior Pancreaticoduodenal Artery Pseudoaneurysm on the Grounds of Chronic Pancreatitis—Case Report and Literature Review

Medicina ◽

10.3390/medicina56110617 ◽

2020 ◽

Vol 56 (11) ◽

pp. 617

Author(s):

Milica Mitrovic ◽

Vladimir Dugalic ◽

Jelena Kovac ◽

Boris Tadic ◽

Stefan Milosevic ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Color Doppler ◽

Abdominal Mass ◽

Subsequent Development ◽

Invasive Treatment ◽

Total Size ◽

Artery Pseudoaneurysm ◽

Life Threatening ◽

Vascular Arcade ◽

Endovascular Coil Embolization

Pancreatic pseudoaneurysm is a rare but life-threatening clinical entity. In this paper, we present a case of a 74-year-old man, who was admitted to our clinic with a diagnosis of an acute on chronic pancreatitis complicated by walled-off-pancreatic-necrosis, with subsequent development of peripancreatic pseudoaneurysm. After initial conservative management, the patient recovered and was discharged from the hospital. However, he soon returned feeling anxious due to a pulsatile abdominal mass. Abdominal Color–Doppler examination, CT scan, and angiography revealed large pancreatic necrotic collection in the total size of 9 cm, with centrally enhancing area of 3.5 cm that corresponded to pseudoaneurysm originating from the posterior pancreaticoduodenal vascular arcade. Considering the size, location of the pseudoaneurysm, feeding vessel, and poor general patients condition, we opted for minimally invasive treatment. Pseudoaneurysm was successfully managed by endovascular coil embolization, i.e., “sandwich technique”.

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Massive Secondary Postpartum Hemorrhage with Uterine Artery Pseudoaneurysm after Cesarean Section

Case Reports in Obstetrics and Gynecology ◽

10.1155/2013/285846 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Ahmet Ozgur Yeniel ◽

Ahmet Mete Ergenoglu ◽

Ali Akdemir ◽

Elmin Eminov ◽

Fuat Akercan ◽

...

Keyword(s):

Cesarean Section ◽

Postpartum Hemorrhage ◽

Uterine Artery ◽

Angiographic Embolization ◽

Artery Ligation ◽

Artery Pseudoaneurysm ◽

Uterine Artery Ligation ◽

Life Threatening ◽

Secondary Postpartum Hemorrhage ◽

Uterine Artery Pseudoaneurysm

Uterine artery pseudoaneurysm is a rare but serious complication of cesarean section. If inadequately treated, it can lead to life-threatening postpartum hemorrhage. Herein, we report the case of a 28-year-old woman who developed secondary postpartum hemorrhage resulting from uterine artery pseudoaneurysm and cesarean scar dehiscence after cesarean section. Angiographic embolization is a safe and effective procedure for treating postpartum hemorrhage resulting from pseudoaneurysm in hemodynamically stable patients. However, uterine artery ligation may be the surgical procedure of choice for hemodynamically unstable patients when fertility preservation is desired.

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Life-Threatening Complications Following Percutaneous Ultrasound-Guided Renal Biopsy: a Rare Case Report

International Archives of Medicine ◽

10.3823/2292 ◽

2017 ◽

Vol 10 ◽

Cited By ~ 1

Author(s):

Yuan-Hung Lo ◽

Po-Jen Hsiao ◽

Szu-Han Chiu ◽

Kun-Lin Wu ◽

Che-Fu Chang ◽

...

Keyword(s):

Renal Biopsy ◽

Hypovolemic Shock ◽

Bleeding Complications ◽

Ultrasound Guided ◽

Basic Tool ◽

Gross Hematuria ◽

Percutaneous Renal Biopsy ◽

Major Complications ◽

Rare Case Report ◽

Life Threatening

Ultrasound-guided percutaneous renal biopsy has been a basic tool for the diagnosis of kidney disease, but minor and major complications cannot be completely avoided. Major complications including gross hematuria, renal hematoma and arteriovenous fistula, and usually develop within 24 hours after renal biopsy. We present an educational case of female having major bleeding complications after renal biopsy with unusual clinical courses. The patient developed hypovolemic shock at 48 hours after renal biopsy along with perirenal hematoma and hemothorax. The case highlight the need to remain the major complications in mind for physicians. Key words: Hemothorax, renal biopsy.

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Atraumatic splenic rupture in chronic pancreatitis with successful embolization

The ASEAN Journal of Radiology ◽

10.46475/aseanjr.v21i2.74 ◽

2020 ◽

Vol 21 (2) ◽

pp. 58-68

Author(s):

Anooja Abdul Salam ◽

Ben Pearch ◽

Lisa Sorger

Keyword(s):

Chronic Pancreatitis ◽

Splenic Artery ◽

Splenic Rupture ◽

Early Recognition ◽

Hypovolemic Shock ◽

Artery Embolization ◽

Splenic Artery Embolization ◽

Threatening Condition ◽

Life Threatening ◽

Atraumatic Splenic Rupture

Atraumatic splenic rupture is uncommon but it is a life threatening condition because of hypovolemic shock. Early recognition and treatment are the keys to asuccessful outcome. We report a case of atraumatic splenic rupture secondary to chronic pancreatitis treated successfully by splenic artery embolization.

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Hemophagocytic Syndrome (HPS) after Autologous Peripheral Stem Cell Tansplantation (APSCT) for Multiple Myeloma (MM)- Successful Treatment with High Dosages of Intravenous Immunoglobulin (IVIG).

Blood ◽

10.1182/blood.v106.11.5359.5359 ◽

2005 ◽

Vol 106 (11) ◽

pp. 5359-5359

Author(s):

Mauricio Ostronoff ◽

Mariana Coutinho Domingues ◽

Fabiana Ostronoff ◽

Rodolfo Calixto ◽

Rodrigo Florencio ◽

...

Keyword(s):

Bone Marrow ◽

Amphotericin B ◽

Current Knowledge ◽

Hypovolemic Shock ◽

Rare Event ◽

Cell Lineage ◽

Gi Tract ◽

Coagulation Tests ◽

Life Threatening ◽

D 12

Abstract HPS is characterized by activation of histiocytes with prominent hemophagocytosis in bone marrow and reticulo-endothelial system, resulting in cytopenias. Reactive HPS (R-HPS) is known to be associated with infection, malignancies and autoimmune disorders. We report a case of R-HPS with massive life-threatening gastro-intestinal (GI) tract bleeding after APSCT for MM which responded to high dosages of IVIG. In May 2005, a 54-year old female diagnosed with MM stage III A, achieved CR after 4 cycles of VAD. APSCT conditioning consisted of L-PAM 140mg/m2. 2x106 CD34+ cells/kg were infused. G-CSF 10μg/kg was started on D0. Pt was placed on cefepime and vancomycin (D+4) and amphotericin B (D+7) for FUO and discontinued after neutrophil recovered (D+10). During aplasia, she received 2 packed RBC and 4 PLT transfusions (irradiated and filtrated). On D+12 G-CSF was discontinued. Four days after thrombocytopenia aggravated (PLT 3000/mm3) and she presented with fever (39°C) and disseminated petechiae. Other coagulation tests were normal. A complete search for infection was negative- cultures (urine and blood) and thoracic, abdominal and sinus CT scan. Pt was again placed on cefepime, vancomycin and amphotericin B without defervescence. In the following 3 days, hypovolemic shock due to profuse GI tract bleeding occurred. Upper endoscopy showed diffuse petechiae and bleeding. Bone marrow (BM) aspirate was performed and revealed 3% histiocytes with hemophagocytic activity. R-HPS was diagnosed. Massive RBC and PLT transfusions were started (4x/day) without response. Search for HSV, EBV, HIV, CMV, auto-immune disease and malignancy were negative. She was on prophylactic acyclovir. On D+21 pt received IVIG 1g/kg/day for 2 days and dexamethasone 40mg for 4 days. Hemorrhage resolved and PLT counts improved. However, on D+30 PLT counts dropped again (PLT 24000/mm3) and BM aspirate showed persistent hemophagocytosis with 4% of histiocytes. A new course of IVIG was given and repeated once a week for 2 weeks when it was no longer needed. BM aspirate on D+39 was normal, with no evidence of hemophagocytosis and there was no recurrence of R-HPS. In this case platelet was the more affected cell lineage resulting in severe and life-threatening hemorrhagic syndrome. The immune mechanism of HPS is not clear, but a defect in immune regulation has been hypothesized. R-HPS after auto-BMT is rare event and appears to be associated with hematological and immunological recovery. We believe that IVIG was effective and its known mechanism of action is compatible with current knowledge of HPS pathophysiology. IVIG might be an effective treatment for R-HPS secondary to auto-BMT.

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Atraumatic splenic rupture in chronic pancreatitis with successful embolization

The ASEAN Journal of Radiology ◽

10.46475/aseanjr.2020.09 ◽

2020 ◽

pp. 58-68

Author(s):

Anooja Abdul Salam ◽

Ben Pearch ◽

Lisa Sorger

Keyword(s):

Chronic Pancreatitis ◽

Splenic Artery ◽

Splenic Rupture ◽

Early Recognition ◽

Hypovolemic Shock ◽

Artery Embolization ◽

Splenic Artery Embolization ◽

Threatening Condition ◽

Life Threatening ◽

Atraumatic Splenic Rupture

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Posttransurethral Resection of Prostate Recurrent Life Threatening Hematuria: A Rare Cause

Case Reports in Urology ◽

10.1155/2016/5895016 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3

Author(s):

MC Arya ◽

Lalit Kumar ◽

Ruchi Mittal ◽

Rajeev Kumar ◽

Mayank Baid

Keyword(s):

Iliac Artery ◽

Internal Iliac Artery ◽

Transurethral Resection Of Prostate ◽

Ct Urography ◽

Artery Ligation ◽

Selective Embolization ◽

Artery Pseudoaneurysm ◽

Contrast Enhanced Ct ◽

Internal Iliac ◽

Life Threatening

Herein, we present a case report of post-TURP (transurethral resection of prostate) recurrent severe hematuria due to right internal iliac artery pseudoaneurysm protruding into bladder lumen. A 60-year-old male presented with recurrent massive hematuria following TURP done elsewhere 15 days before. His hemoglobin was 4 gm/dL after 13 units of blood transfusion and repeated clot evacuations. His blood urea, serum creatinine, and coagulation profile studies were normal. Ultrasonography of abdomen showed multiple clots in the bladder. Cystoscopy revealed clots with a right posterolateral wall unhealthy area. After stabilizing the patient, contrast enhanced CT urography revealed intravesical aneurysm. CT angiography showed pseudoaneurysm of a branch of internal iliac artery protruding into urinary bladder lumen. We referred patient to selective embolization of the lesion but the procedure was unsuccessful. At last, ipsilateral internal iliac artery ligation relieved hematuria. But on postoperative day 2, patient suddenly collapsed and deceased, presumably due to cardiomorbidities.

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Left gastric artery pseudoaneurysm as a sequelae of chronic pancreatitis: recognizing a life-threatening complication

Open Medicine ◽

10.2478/s11536-013-0302-2 ◽

2014 ◽

Vol 9 (3) ◽

pp. 370-373

Author(s):

Deepak Pattanshetty ◽

Pradeep Bhat

Keyword(s):

Abdominal Pain ◽

Chronic Pancreatitis ◽

Early Recognition ◽

Left Gastric Artery ◽

Gastric Artery ◽

Artery Pseudoaneurysm ◽

Life Threatening ◽

History Of ◽

Life Threatening Complication ◽

High Index Of Suspicion

AbstractLeft gastric artery pseudoaneurysm is a rare but important life-threatening complication of chronic pancreatitis. We report a case of a 54-year-old male with chronic pancreatitis who presented with history of severe abdominal pain. Following an initial suspicion of acute pancreatitis, a computed tomography of abdomen was obtained that showed a large left gastric artery pseudoaneurysm (4×4 cm) with circumferential thrombosis. The patient then underwent successful angiographic coiling of the aneurysm, thus preventing a potentially life-threatening hemorrhage. In conclusion, in patients with a history of chronic pancreatitis who present with abdominal pain, a high index of suspicion should be maintained for alternate causes of abdominal pain such as visceral aneurysms involving left gastric artery. Early recognition is critical and consequences of missing these lesions can be catastrophic.

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Positive Outcome of Heterotopic Pregnancy Following Ovulation Induction: A Rare Case Report

TAJ Journal of Teachers Association ◽

10.3329/taj.v22i2.37746 ◽

2009 ◽

Vol 22 (2) ◽

pp. 287-288

Author(s):

S Jesmin ◽

N Akhte ◽

N Naha ◽

N Shamima

Keyword(s):

Ovulation Induction ◽

Clomiphene Citrate ◽

Rare Event ◽

Positive Outcome ◽

Tubal Pregnancy ◽

Heterotopic Pregnancy ◽

Singleton Pregnancy ◽

Rare Case Report ◽

Threatening Condition ◽

Life Threatening

We report a combined intra-uterine and ruptured tubal pregnancy following ovulation induction by clomiphene citrate (cc) and timed intercourse. The diagnosis of heterotopic pregnancy (HP) is the major problem until occurrence of tubal rupture. Because HP is a life threatening condition, the diagnosis should be made as soon as possible. In a spontaneous conception HP is a rare event. The risk of HP significantly increases after ovulation induction. Clomiphene itself should be associated with a high HP rare. We present a case with normally developing intra uterine singleton pregnancy successfully with synchronous tubal pregnancy following ovulation induction by cc.TAJ 2009; 22(1): 287-288

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A rare case of spontaneous rupture of renal artery pseudoaneurysm in a previously hypertensive patient

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh210303080s ◽

2021 ◽

pp. 80-80

Author(s):

Dejan Stevanovic ◽

Nebojsa Mitrovic ◽

Damir Jasarovic ◽

Aleksandar Lazic ◽

Branko Lukic

Keyword(s):

Renal Artery ◽

Systemic Disease ◽

Hypovolemic Shock ◽

Retroperitoneal Hematoma ◽

Prior History ◽

Renal Surgery ◽

Artery Pseudoaneurysm ◽

Intraperitoneal Hemorrhage ◽

Life Threatening ◽

Renal Artery Pseudoaneurysm

Introduction. The renal artery and segmental renal artery pseudoaneurysm is a rare and usually asymptomatic vascular lesion which in most of the cases thrombose spontaneously, but at same time it can be a source of life-threatening hemorrhage and shock. Today, these pseudoaneurysms are discovered with increasing frequency due to unrelated abdominal imaging or on screening work-ups for hypertension, as well as widespread use of angiography. Typically, they are seen in patients after trauma, inflammation, or renal surgery or biopsy. Case outline. In our case, a 52-year-old male patient with no prior history of surgery, significant abdominal trauma and systemic disease, presented with left flank pain and signs of hypovolemic shock that manifested before the admission in the surgical emergency room. The CT scan promptly demonstrated rupture of large retroperitoneal hematoma with the massive intraperitoneal hemorrhage. The angiography confirmed the rupture of the renal artery pseudoaneurysm. The patient had the urgent operation. A life-saving nephrectomy was performed while intraperitoneal hemorrhage and retroperitoneal hematoma was evacuated. The fourteen days after surgery the patient was discharged fully recovered, with normal diuresis and serum levels of creatinine and urea within referential values. During the period of hospitalization, he was diagnosed and treated hypertension. Conclusion. Rupture of pseudoaneurysms with the following hemorrhage into the intraperitoneal cavity and retroperitoneum is a life-threatening condition, as proven with this case in which hypovolemic shock manifested before the admission. We would like to highlight the importance of high blood-pressure control and the importance of regular check-ups.

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