The Management of Multi-Site, Bleeding, Visceral Artery Pseudoaneurysms, Secondary to Necrotising Pancreatitis

We present the case of a 45-year-old man, who presented to his local casualty department with severe epigastric pain following an alcohol binge, and was subsequently diagnosed with acute pancreatitis. Pancreatic necrosis with multiple collections ensued, necessitating transfer to an intensive care unit (ITU) in a tertiary hepatopancreaticobiliary centre. Initially, the patient appeared to slowly improve and was discharged to the ward, albeit following a prolonged ITU admission. However, during his subsequent recovery, he suffered multiple episodes of haematemesis and melaena associated with haemodynamic instability and requiring repeat admission to the ITU. Computerised tomographic angiography, followed by visceral angiography, was used to confirm the diagnosis of multisite visceral artery pseudoaneurysms, secondary to severe, necrotising pancreatitis. Pseudoaneurysms of the splenic, left colic and gastroduodenal arteries were sequentially, and successfully, radiologically embolised over a period of 9 days. Subsequent sequelae of radiological embolisation included a clinically insignificant splenic infarct, and a left colonic infarction associated with subsequent enterocutaneous fistula formation. The patient made a prolonged, but successful, recovery and was discharged from hospital after 260 days as an in-patient. This case illustrates the rare complication of three separate pseudoaneurysms, secondary to acute pancreatitis, successfully managed radiologically in the same patient. This case also highlights the necessity for multidisciplinary involvement in the management of pseudoaneurysms, an approach that is often most successfully achieved in a tertiary setting.

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Rare complication of milk-alkali ingestion: severe pancreatitis and acute kidney injury in a chronic hypocalcaemic patient with DiGeorge’s syndrome

BMJ Case Reports ◽

10.1136/bcr-2018-226761 ◽

2019 ◽

Vol 12 (3) ◽

pp. e226761 ◽

Cited By ~ 1

Author(s):

Rajarshi Bhadra ◽

Fareeha Ahmed Khan ◽

Mona Soliman ◽

Meyappan Somasundaram ◽

Daniel V Iltchev ◽

...

Keyword(s):

Acute Pancreatitis ◽

Renal Dysfunction ◽

Epigastric Pain ◽

Calcium Supplementation ◽

Rare Complication ◽

Biliary Duct ◽

Thiazide Diuretics ◽

Prolonged Stay ◽

Calcium Supplements ◽

Severe Renal Dysfunction

Injudicious use of over-the-counter calcium supplements has resulted in increased incidences of hypercalcaemia and related complications. We present a case of acute pancreatitis in a chronic hypocalcaemic patient of DiGeorge’s syndrome. The patient came into the ED with sepsis syndrome, right upper quadrant and epigastric pain and no obvious source of infection. Lab results and imaging were indicative of acute pancreatitis. There was severe renal dysfunction. The patient needed haemodialysis and had a prolonged stay in intensive care. The medical history was negative for biliary duct pathology or alcohol use. The patient had vomiting and diarrhoea in the nursing home for about a week, but she continued to receive her regular medications that included the calcium supplements and thiazide diuretics. It is likely that a complex interplay between calcium supplementation, dehydration and thiazide diuretics resulted in the development of acute pancreatitis and severe renal dysfunction in a chronic hypocalcaemic patient.

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Gastrosplenic Fistula and Coeliac Artery Occlusion

Surgical Case Reports ◽

10.31487/j.scr.2020.02.14 ◽

2020 ◽

pp. 1-3

Author(s):

Wen Jye Wong ◽

Tze Yang Chin ◽

Wen Jye Wong

Keyword(s):

Functional Status ◽

Ct Angiography ◽

Epigastric Pain ◽

Case Reports ◽

Rare Complication ◽

Arterial Disease ◽

Fistula Formation ◽

Arterial Tree ◽

Coeliac Artery ◽

Poor Functional Status

Gastrosplenic fistula (GSF) is a very rare complication of several disease processes and can lead to catastrophic bleeding, necessitating emergent treatment. Splenic or gastric lymphomas are the predominant causes, with trauma and gastric surgery also implicated in several case reports. We present a case of a gastrosplenic fistula resulting from occlusion of the coeliac artery. To our knowledge, this is the first reported case of a GSF resulting from severe intra-abdominal arterial disease. A 60-year-old male initially presented to the emergency department with epigastric pain. He had an extensive medical history, including dialysis-dependent end-stage renal failure, atrial fibrillation, coronary artery disease, and multiple previous abdominal surgeries. Investigation with CT angiography revealed calcified occlusion of the coeliac artery as well as extensive calcification throughout his aorta and arterial tree. A diagnosis of mesenteric angina was made, but due to his poor functional status, he was not suitable for surgical or transcatheter interventions. He was treated symptomatically, but a month later developed sudden worsening of his epigastric pain, followed by large volume haematemesis. CT angiography showed a GSF with extensive gastric necrosis. Due to his poor functional status and rapid deterioration, he opted for palliation and passed away two days later. It has been postulated that GSF develops from the invasion of malignant tissue from the stomach to the spleen or vice versa, and subsequent necrosis of this tissue results in fistula formation. This case demonstrates that the invasion of an adjacent organ may not be necessary; necrosis itself can cause erosion that ultimately results in fistula formation.

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Spectrum of acute, recurrent and chronic pancreatitis in children

Journal of the Pakistan Medical Association ◽

10.47391/jpma.540 ◽

2020 ◽

pp. 1-11

Author(s):

Muhammad Imran ◽

Sabeen Abid Khan ◽

Munir Iqbal Malik

Keyword(s):

Acute Pancreatitis ◽

Chronic Pancreatitis ◽

Retrospective Study ◽

Medical Records ◽

Clinical Presentation ◽

Clinical Laboratory ◽

Epigastric Pain ◽

Paediatric Population ◽

Older Children ◽

Successful Recovery

Abstract Objective: To determine the clinical presentation, aetiology and outcome of pancreatitis in paediatric population. Method: The retrospective study was conducted at Shifa International Hospital, Islamabad, Pakistan, and comprised data of children with pancreatitis presenting between 2013 and 2018. Medical records were reviewed and findings of clinical, laboratory workup and management were noted on a specifically developed proforma. Data was analysed using SPSS 23. Results: Of the 51 subjects, 28(54.9%) were boys. The overall mean age was 10.6+4.9 years. The most frequent clinical symptom was epigastric pain 39(76.5%). The most common aetiology was gallstones/pancreatic stones 19(37.25%). Mean hospital stay was 5.1± 1.8 days, and it was longer in children aged up to 5 years compared to older children (p<0.05). Acute pancreatitis was seen in 23(45.09%) patients, followed by recurrent 19(37.25%) and chronic 9(17.64%). There was no mortality. Conclusion: Timely diagnosis and prompt management of hemodynamic status could lead to successful recovery without any serious complications in paediatric pancreatitis. Continuous...

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Sentinel Bleeding as a Sign of Gastroaortic Fistula Formation after Oesophageal Surgery

Case Reports in Surgery ◽

10.1155/2014/614312 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

M. Uittenbogaart ◽

M. N. Sosef ◽

J. van Bastelaar

Keyword(s):

Epigastric Pain ◽

Blood Clot ◽

Rare Complication ◽

Neoadjuvant Chemoradiation ◽

Sudden Onset ◽

Warning Signs ◽

Fistula Formation ◽

Oesophageal Wall ◽

Patient Reported ◽

Oesophageal Surgery

Gastroaortic fistula formation is a very rare complication following oesophageal resection and, in most cases, leads to sudden death. We report the case of a 65-year-old male with an adenocarcinoma of the oesophagus who underwent neoadjuvant chemoradiation followed by a minimally invasive transthoracic oesophagectomy with gastric tube reconstruction and intrathoracic anastomosis. After an uneventful postoperative course and hospital discharge, the patient reported blood regurgitation on postoperative day 23. Endoscopy revealed an adherent blood clot on the oesophageal wall, which after dislocation caused exsanguination. Autopsy determined the cause of death being massive haemorrhage due to a gastroaortic fistula. The sudden onset of haemorrhage makes this condition particularly difficult to treat. Recognition of warning signs such as thoracic or epigastric pain, regurgitation of blood, or the passing of bloody stools or melena is crucial in the early detection of fistula and may improve patient outcome.

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A Rare Complication of Composite Dual Mesh: Migration and Enterocutaneous Fistula Formation

Case Reports in Surgery ◽

10.1155/2015/293659 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 4

Author(s):

Ozgur Bostanci ◽

Ufuk Oguz Idiz ◽

Memet Yazar ◽

Mehmet Mihmanli

Keyword(s):

Hernia Repair ◽

Rare Complication ◽

Enterocutaneous Fistula ◽

Late Complication ◽

Abdominal Hernia ◽

Fistula Formation ◽

Mesh Migration ◽

Foreign Substance ◽

Umbilical Hernia Repair ◽

Dual Mesh

Introduction. Mesh is commonly employed for abdominal hernia repair because it ensures a low recurrence rate. However, enterocutaneous fistula due to mesh migration can occur as a very rare, late complication, for which diagnosis is very difficult.Presentation of Case. Here we report the case of an enterocutaneous fistula due to late mesh migration in a mentally retarded, diabetic, 35-year-old male after umbilical hernia repair with composite dual mesh in 2010.Discussion. Mesh is a foreign substance, because of that some of the complications including hematoma, seroma, foreign body reaction, organ damage, infection, mesh rejection, and fistula formation may occur after implantation of the mesh. In the literature, most cases of mesh-associated enterocutaneous fistula due to migration involved polypropylene meshes.Conclusion. This case serves as a reminder of migration of composite dual meshes.

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Nontraumatic Acute Elevation of Pancreatic Enzymes following Percutaneous Nephrolithotomy: A Rare Complication

Case Reports in Urology ◽

10.1155/2017/7430328 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Nikolaos Ferakis ◽

Antonios Katsimantas ◽

Georgios Zervopoulos ◽

Vasileios Klapsis ◽

Spyridon Paparidis ◽

...

Keyword(s):

Acute Pancreatitis ◽

Systemic Inflammatory Response Syndrome ◽

Percutaneous Nephrolithotomy ◽

Serum Amylase ◽

Epigastric Pain ◽

Rare Complication ◽

Signs And Symptoms ◽

Imaging Studies ◽

Acute Elevation ◽

Pathologic Findings

Herein, we report the case of a 48-year-old female who developed nontraumatic acute pancreatitis following left supracostal Percutaneous Nephrolithotomy. Three hours postoperatively, the patient developed fever with signs and symptoms consistent with hydrothorax, which was confirmed radiologically and was managed conservatively. The following days, the patient developed manifestations of Systemic Inflammatory Response Syndrome with epigastric pain, nausea, and vomiting. Blood, urine, and sputum cultures were negative. Serum amylase and lipase levels were elevated 3 and 13 times above the normal level, respectively. Imaging studies revealed no pathologic findings from pancreas. These findings were consistent with the diagnosis of acute pancreatitis.

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Necrotising Pancreatitis and Diabetes Associated with Disseminated Small Cell Carcinoma of Lung

Scottish Medical Journal ◽

10.1177/003693308803300612 ◽

1988 ◽

Vol 33 (6) ◽

pp. 377-377 ◽

Cited By ~ 2

Author(s):

A.T. Evans

Keyword(s):

Acute Pancreatitis ◽

Cell Carcinoma ◽

Small Cell Carcinoma ◽

Epigastric Pain ◽

Small Cell ◽

Lung Tumour ◽

Cigarette Smokers ◽

Cytotoxic Treatment ◽

Necrotising Pancreatitis ◽

Conventional Risk Factors

Although tumour metastases to the pancreas and peripancreatic lymph nodes are found commonly at necropsy in cases of small cell carcinoma of lung, tumour-induced acute pancreatitis is described rarely. A case of metastasis-associated necrotising pancreatitis with the unusual presentation of epigastric pain followed by diabetes is described here. Patients (particularly cigarette smokers) with none of the conventional risk factors for acute pancreatitis merit chest radiography and if indicated prompt cytotoxic treatment.

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A rare complication of prosthetic mesh repair of a ventral incisional hernia: erosion and enterocutaneous fistula formation

International Surgery Journal ◽

10.18203/2349-2902.isj20180847 ◽

2018 ◽

Vol 5 (3) ◽

pp. 1141

Author(s):

Sridhar Reddy M. ◽

Naresh M. ◽

Alok Rath ◽

Saleem M. A.

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Mesh Repair ◽

Rare Complication ◽

Primary Anastomosis ◽

Enterocutaneous Fistula ◽

Incisional Hernia Repair ◽

Fistula Formation ◽

Mesh Migration ◽

Ventral Incisional Hernia

Recurrence of hernia has significantly reduced with mesh repair. But mesh is a foreign material which has its own complications like haematoma, infection, sinus formation, mesh migration and erosion. Mesh migration and erosion although rare, is a challenging complication which requires surgical intervention. There are very few such mesh related complications reported in the literature. Authors report a case of mesh erosion resulting in chronic infection and formation of enterocutaneous fistula following incisional hernia repair 5 years after surgery. In this case small bowel segment containing mesh was resected and primary anastomosis was done. Migration of mesh also depends on the nature of mesh (biomaterial) and type of fixation. Although many techniques of hernia repair have been described (open or laparoscopic) care must be taken to fix the mesh to abdominal wall for prevention of delayed complications. Different techniques of repair, types of meshes have been discussed to prevent such complications.

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Ep.Fri.329 Severe Acute Pancreatitis in Pregnancy Secondary to Hypertriglyceridemia – A Case Report and Literature Review

British Journal of Surgery ◽

10.1093/bjs/znab312.056 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Toks Fadipe ◽

Sangara Narayanan Narayanasamy ◽

Pradeep Thomas

Keyword(s):

Acute Pancreatitis ◽

Case Report ◽

Epigastric Pain ◽

Post Partum ◽

Rare Complication ◽

Medical Treatments ◽

Targeted Screening ◽

Rising Incidence ◽

Pseudocyst Formation ◽

In Pregnancy

Abstract Background Hypertriglyceridemia is a common and well characterized physiological phenomenon in pregnancy. Rarely does it complicate the pregnancy causing acute pancreatitis (APIP). The majority of APIP cases arise secondary to gallstones. Hyperlipidaemia induced pancreatitis is a rarer cause with relatively worse outcomes with increased incidences of preterm delivery and pseudocyst formation. Case Report A 38-years-old woman at 29 weeks gestation presented with epigastric pain. The initial investigations revealed raised inflammatory markers, elevated amylase and hypertriglyceridemia. A diagnosis of APIP was made, prompting transfer to ITU. Foetal compromise necessitated an emergency Caesarean delivery. Post-partum, her clinical condition improved with NG feeding, bezafibrates and IV antibiotics. Her baby was transferred to a nearby tertiary neonatal unit with no immediate complications. Discussion Hyperlipidemia induced APIP requires intensive treatment. Various medical treatments for hypertriglyceridemia, such as fibrates and insulin infusions, have been described. Plasmapheresis in severe cases may benefit reducing the triglycerides level. Considering maternal and foetal morbidity and mortality, early diagnosis and multidisciplinary input is required to treat and reduce complications. Conclusion APIP is a serious and rare complication of pregnancy. The current lack of consensus on treatment of APIP warrants further inquiry, to minimise poor neonatal outcomes. The merits of routine screening for gestational hypertriglyceridemia are yet to be elucidated; the morbidity associated with APIP, coupled with its rising incidence justify a targeted screening programme. Keywords Pancreatitis, Pregnancy, Hypertriglyceridemia.

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Painless spontaneous haemoperitoneum secondary to a uterine leiomyoma/fibroid: unusual presentation of a life-threatening differential

BMJ Case Reports ◽

10.1136/bcr-2021-243465 ◽

2021 ◽

Vol 14 (10) ◽

pp. e243465

Author(s):

Chiamaka Maduanusi ◽

Sathiyaa Balachandran ◽

Sahathevan Sathiyathasan ◽

Kazal Omar

Keyword(s):

Uterine Leiomyoma ◽

Rare Complication ◽

Abdominal Mass ◽

Uterine Fibroids ◽

Reproductive Age ◽

Haemodynamic Instability ◽

Hypovolaemic Shock ◽

Important Differential Diagnosis ◽

Life Threatening ◽

Definitive Management

This is a case of a 47-year-old woman with a spontaneous haemoperitoneum secondary to uterine leiomyomas (fibroids), an important differential diagnosis in patients with uterine fibroids and hypovolaemic shock. Uterine fibroids are very common in women of reproductive age, yet little is taught about their potential to cause hypovolaemic shock. Although it is a rare complication, given the prevalence of fibroids, it is important to bear this life-threatening differential in mind to optimise the care for these women. Presentation typically involves abdominal pain, syncope, haemodynamic instability and an intra-abdominal mass. CT of the abdomen and pelvis can be helpful in identifying the source of the haemoperitoneum, but should not delay surgery, which is the definitive management.

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