Our Experience with the Treatment of Visceral Pseudoaneurysm due to Pancreatic Pseudocyst: A Case Report

Jaroslav Sekáč1*, Júlia Bujňáková1, Martin Huťan2 and Lukáš Mičulík2

12nd Department of Surgery, Comenius University, Bratislava, Slovakia
2Department of Surgery, Landesklinikum Hainburg, Donau, Austria

^*Correspondance to: Jaroslav Sekáč 

 PDF  Full Text DOI: 10.25107/2474-1647.2706

Abstract

Introduction: The development of a false aneurysm- a pseudoaneurysm "as a consequence" of pancreatic pseudocyst erosion is often the fatal cause of intra-abdominal bleeding. Autodigestion causes leakage of pancreatic proteolytic enzymes which weakens the wall of adjacent visceral arteries. Most often it affects arteria lienalis in 30% to 50% and gastroduodenal artery is in 10% to 15% of cases [1]. Pseudoaneurysms of gastroduodenal artery: (PAGD) are rare and mostly associated with pancreatitis. It is very important to think of the possibility of developing of this complication already during the treatment of a pancreatic pseudocyst, to recognize them in time and immediately cure them in order to avoid possible life-threatening conditions [2]. This work is based on the example of our successfully treated patient points to important moments in the formation and subsequent treatment of a pseudoaneurysm associated with a Pancreatic Pseudocyst (PPAP). Methods: Bleeding from a pseudoaneurysm associated with a pancreatic pseudocyst is a very rare and specific complication, therefore making of prospective or retrospective studies is of no benefit regarding the size of the obtained file. Benefits can be seen in evaluating the treatment of this complication and in pointing out the wrong steps which should be avoided in the future. In this specific example we demonstrate the pre-surgery condition, surgical treatment and post-surgery condition of our successfully treated patient. Case presentation: A 35-years-old patient was admitted to the Gastroenterology Clinic due to acute pancreatitis Balthazar E with forming pseudocysts. He was hospitalized for 14 days. The patient was released into outpatient care without any consultation with a surgeon or intervention radiologist. Subsequently he was transported by an ambulance in a hemorrhagic shock with the urgent need for surgery. The cause was arterial bleeding into the pancreatic pseudocyst from the basin of a. lienalis. A pseudoaneurysm of a. gastroduodenal is the secondary finding. Due to the urgency of the situation, the extreme size and the location of the pseudoaneurysm in acute inflammation altered area, we have decided for rapid surgery in order to stabilize the patient's condition. Bleeding was stopped by the cross stitches in the pseudocyst wall (we came to the conclusion that the risk of dissecting and suspending of the pseudoaneurysm exceeds the benefit in the acute stage). An important step (as confirmed later) was the bursectomy sewing at the end of surgery to control possible recurring bleeding into the pancreas pseudocyst. After the consultation with the intervention radiologist the occlusion of the pseudoaneurysm was scheduled 48 h after the stabilization of the patient's condition. On the day of the planned interventional radiological treatment the patient bled again into the pseudocyst which was detected early by leakage of hemorrhagic contents through the bursectomy. A second urgent surgery was needed with bleeding stops through the wall of the pseudocyst with cross stitches and packing. Subsequently interventional radiological treatment was performed within 48 h with the occlusion of the pseudoaneurysm. The patient was monitored by the surgeon and after 5-years the hernioplasty with a mesh after the bursectomy was performed. The patient was completely without difficulties. He weighs 10 kg more. The control CT angiography after 5-years since the surgery showed no signs of pseudocysts in the area of pancreas. The pseudoaneurysm is closed and regraded. Conclusion: Arterial pseudoaneurysms in pancreatitis are accompanied by non-specific symptoms. We should think of GDA pseudoaneurysm in each patient with bleeding into the pancreas

Keywords

Pancreatic pseudocyst; Gastroduodenal artery pseudoaneurysm; Bursectomy

Cite the article

Sekáč J, Bujňáková J, Huťan M, Mičulík L. Our Experience with the Treatment of Visceral Pseudoaneurysm due to Pancreatic Pseudocyst: A Case Report. Clin Surg. 2020; 5: 2706..