Non-operative Management of Necrotic Pancreatic Collection and Bleeding Pseudoaneurysm Communicating with Bowel Lumen at Multiple Sites: a Case Report and Review of the Literature

2016 ◽  
Vol 25 (1) ◽  
pp. 109-114 ◽  
Author(s):  
Roshan Razik ◽  
Gary R. May ◽  
Fred Saibil
Keyword(s):  
Operative Management ◽  
Gastroduodenal Artery ◽  
Pancreatic Pseudocysts ◽  
Gallstone Pancreatitis ◽  
Endoscopic Retrograde ◽  
Pancreaticoduodenal Artery ◽  
Edematous Pancreatitis ◽  
Walled Off Necrosis ◽  
Non Operative Management ◽  
Guided Therapy

Pancreatic pseudocysts and foci of walled-off necrosis (WON) are well-known complications of acute pancreatitis. We present a case of severe gallstone pancreatitis complicated by WON, fistulization to the bowel and gastrointestinal bleeding. Bleeding was localized to a pseudoaneurysm of the gastroduodenal artery within the WON using imaging and endoscopy. Angiography and image-guided therapy were then used to control bleeding with coil-embolization. To our knowledge, this is the first report of non-operative management of a patient with severe pancreatitis complicated by WON and a bleeding pseudoaneurysm with multiple communications to the hollow viscera. Therapeutic options are discussed and a thorough literature review is included. Abbreviations: EGD: esophagogastroduodenoscopy; ERCP: endoscopic retrograde cholangiopancreatography; GDA: gastroduodenal artery; GI: gastrointestinal; IEP: interstitial edematous pancreatitis; IPDA: inferior pancreaticoduodenal artery; WON: walled-off necrosis.

scholarly journals An Unusual Recurrent Bile Leak Following High Grade Liver Trauma

2021 ◽  
Vol 11 (3) ◽  
pp. 137-140
Author(s):  
Morgan E Jones ◽  
Ee Jun Ban ◽  
Charles H. C. Pilgrim
Keyword(s):  
Liver Injury ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
High Speed ◽  
Bile Leak ◽  
Biliary Tree ◽  
Operative Management ◽  
Liver Trauma ◽  
Post Injury ◽  
Endoscopic Retrograde ◽  
Non Operative Management

Non-operative management of blunt liver injury has been demonstrated as a safe and effective treatment for most grades of injury. As the severity of liver injury increases, so does the risk of complications. A 21-year-old male was brought to the trauma center following a high speed motorbike accident. He underwent a laparotomy and angioembolization for a Grade 4 liver injury. A biloma was diagnosed on Day 18 post injury, and he underwent Endoscopic Retrograde Cholangiopancreatography and biliary stenting which were unsuccessful. There were 2 re-admissions for infected perihepatic collections. In this case, an Endoscopic Retrograde Cholangiopancreatography was not a helpful procedure due to a disconnected liver segment, and morbidity occurred due to instrumentation of the biliary tree (the likely cause of infected biloma). Hepatic resection should be considered for patients who fail non-operative management. Further assessment of efficacy using a larger dataset for analysis is required.

scholarly journals Visceral Arterial Aneurysms Complicating Endoscopic Retrograde Cholangiopancreatography

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Vinaya Gaduputi ◽  
Hassan Tariq ◽  
Anil Dev
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Artery Aneurysm ◽  
Gastroduodenal Artery ◽  
Endoscopic Retrograde ◽  
Pancreaticoduodenal Artery ◽  
Diffuse Abdominal Pain ◽  
Artery Pseudoaneurysm ◽  
Splanchnic Artery ◽  
Gastroduodenal Artery Aneurysm ◽  
Arterial Aneurysms

We report this case of a 74-year-old man with altered anatomy secondary to Billroth-II surgery who underwent endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis and subsequently developed severe diffuse abdominal pain with drop in hemoglobin. Patient was found to have hemorrhagic shock requiring aggressive resuscitative measures. Patient was found to have large peripancreatic hematoma secondary to bleeding from gastroduodenal and superior pancreaticoduodenal artery pseudoaneurysms. Gastroduodenal artery aneurysm is the rarest of all the splanchnic artery aneurysms, and to our knowledge this is the only reported case of a gastroduodenal artery pseudoaneurysm complicating ERCP.

Non-operative management of traumatic pancreatic pseudocysts associated with pancreatic duct laceration in children

1998 ◽  
Vol 28 (1) ◽  
pp. 5-8 ◽  
Author(s):  
J. Lucaya ◽  
Elida Vázquez ◽  
Ferran Caballero ◽  
Peter G. Chait ◽  
Alan Daneman ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Operative Management ◽  
Pancreatic Pseudocysts ◽  
Non Operative Management

True aneurysms of the pancreaticoduodenal artery: Successful non-operative management

Surgery ◽  
2006 ◽  
Vol 139 (5) ◽  
pp. 608-616 ◽  
Author(s):  
Serban Bageacu ◽  
Muriel Cuilleron ◽  
David Kaczmarek ◽  
Jack Porcheron
Keyword(s):  
Operative Management ◽  
Pancreaticoduodenal Artery ◽  
Non Operative Management

scholarly journals 883 Modified Framework for The Management of Acute Gallstone Disease During The COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A White ◽  
J Brewer ◽  
E Efthimiou ◽  
H Khwaja ◽  
G Bonanomi
Keyword(s):  
Gallstone Disease ◽  
Operative Management ◽  
Definitive Treatment ◽  
Biliary Colic ◽  
Gallstone Pancreatitis ◽  
Early Laparoscopic Cholecystectomy ◽  
Global Pandemic ◽  
Early Adoption ◽  
Efficient Resource ◽  
Non Operative Management

Abstract Introduction On 12/03/2020 WHO declared SARS-CoV-2 a global pandemic. PHE and RCS advised non-operative management wherever possible, changing management of acute gallstone disease from early laparoscopic cholecystectomy to conservative treatment and frequent percutaneous drainage. Planning, prioritisation, and implementation of “COVID-Safe” pathways presented multi-factorial challenges throughout the NHS. Method Prospective data of patients admitted with acute gallstone pathology was collected at Chelsea & Westminster Hospital (23/03/2020-16/08/2020), and prioritised using Tokyo, FSSA and RCS Guidance. A restructured “Gallbladder-pathway” was implemented comprising trust-wide referral proforma, weekly clinical planning MDT meetings and dedicated theatre lists. Results Sixty-eight patients were prioritized as either “Urgent” (25), “Expedited” (12) or “Elective” (31); comprising gallstone pancreatitis (11), acute cholecystitis (53), obstructive jaundice (12) and biliary colic (8). 12 patients required cholecystostomies. During the “Peak” (23/3/20-02/06/2020) no cholecystectomies were performed, 10 in “Recovery” (02/06/20-06/07/20) in NCEPOD theatre, 21 in “Resolution” (06/07/20-18/08/20) since implementation of the “Gallbladder-Pathway”. Eleven patients (16%) re-presented while awaiting definitive treatment, none critically ill. The highest number of re-presentations was in “Urgent” patients (36%) and those with cholecystostomy (45%). Conclusions Early adoption of a modified “Gallbladder-pathway” during the pandemic allowed accurate case stratification, efficient resource allocation and safe care. Our model enabled prompt service recovery and a framework to navigate future disruption.

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