Sorabh Kapoor1, Pankaj Rao, Sujoy Pal, Tushar Kanti Chattopadhyay. 1. Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. sorabhkapoor@hotmail.com
Abstract
CONTEXT: Pseudoaneurysms of peripancreatic arteries usually arise as a complication of acute and chronic pancreatitis. These pseudoaneurysms may either bleed intra abdominally following rupture or may erode into the adjacent hollow viscera and manifest as gastrointestinal bleeding. Pseudoaneurysms rarely communicate with the pancreatic duct and bleeding occurs from the ampulla of Vater in the form of hemosuccus pancreaticus. CASE REPORT: We report a patient with chronic pancreatitis who presented with hemosuccus pancreaticus. Contrast enhanced computerized tomography and angiography revealed bleeding from a left gastric artery pseudoaneurysm. Despite multiple attempts, embolization was unsuccessful due to arterial spasm. The patient was successfully managed at emergency surgery by excision of the pseudoaneurysm sac and ligation of the left gastric artery. CONCLUSION: Bleeding from visceral artery pseudoaneurysms rarely manifests itself as hemosuccus pancreaticus. Most cases can be managed by angio-embolization. However, in patients with recurrent bleeding or failed embolization, emergency surgery is required.
CONTEXT: Pseudoaneurysms of peripancreatic arteries usually arise as a complication of acute and chronic pancreatitis. These pseudoaneurysms may either bleed intra abdominally following rupture or may erode into the adjacent hollow viscera and manifest as gastrointestinal bleeding. Pseudoaneurysms rarely communicate with the pancreatic duct and bleeding occurs from the ampulla of Vater in the form of hemosuccus pancreaticus. CASE REPORT: We report a patient with chronic pancreatitis who presented with hemosuccus pancreaticus. Contrast enhanced computerized tomography and angiography revealed bleeding from a left gastric artery pseudoaneurysm. Despite multiple attempts, embolization was unsuccessful due to arterial spasm. The patient was successfully managed at emergency surgery by excision of the pseudoaneurysm sac and ligation of the left gastric artery. CONCLUSION:Bleeding from visceral artery pseudoaneurysms rarely manifests itself as hemosuccus pancreaticus. Most cases can be managed by angio-embolization. However, in patients with recurrent bleeding or failed embolization, emergency surgery is required.