Peripancreatic arterial pseudoaneurysm in the background of chronic pancreatitis: clinical profile, management, and outcome

Hepatic Artery Pseudoaneurysm in an Infant With Pancreatitis

Hepatic artery pseudoaneurysm (HAP) is an uncommon yet critical complication of acute pancreatitis. This case delves into the unusual scenario of a two-month-old male infant with a familial history of pancreatitis who develops the condition himself. Despite initial treatment, the infant's symptoms worsened, unveiling a pancreatic pseudocyst (PCC) and an atypical pseudoaneurysm stemming from the hepatic artery, a rare complication in acute pancreatitis. The pseudoaneurysm's confirmation through selective angiography and its subsequent management using embolization is highlighted. This report emphasizes the rarity of hepatic artery pseudoaneurysm in the context of acute pancreatitis, stressing the need for thorough imaging to spot arterial involvement. Early identification via selective angiography remains crucial due to the high risks associated with pseudoaneurysm rupture, underscoring the urgency for prompt intervention. In summary, this case spotlights the infrequent occurrence of hepatic artery pseudoaneurysm secondary to acute pancreatitis in an infant. It stresses the importance of swift recognition and intervention to avert potentially life-threatening complications.

Vascular complications of chronic pancreatitis and its management

Chronic pancreatitis is a chronic fibro-inflammatory disorder of the pancreas, resulting in recurrent abdominal pain, diabetes mellitus, and malnutrition. It may lead to various other complications such as pseudocyst formation, benign biliary stricture, gastric outlet obstruction; and vascular complications like venous thrombosis, variceal and pseudoaneurysmal bleed. Development of varices is usually due to chronic venous thrombosis with collateral formation and variceal bleeding can easily be tackled by endoscopic therapy. Pseudoaneurysmal bleed can be catastrophic and requires radiological interventions including digital subtraction angiography followed by endovascular obliteration, or sometimes with a percutaneous or an endoscopic ultrasound-guided approach in technically difficult situations. Procedure-related bleed is usually venous and mostly managed conservatively. Procedure-related arterial bleed, however, may require radiological interventions.

Acute pancreatitis complicated with peripancreatic pseudoaneurysm and subsequent intra-abdominal hematoma

Acute pancreatitis is a common disease, but peripancreatic pseudoaneurysm is rare. Bleeding from peripancreatic pseudoaneurysm without connection to GI tract may delay treatment and cause mortality. Being aware of this rare complication after acute pancreatitis is important.

Hepatic artery pseudoaneurysm caused by chronic pancreatitis: Case report and literature review

RATIONALE

Visceral artery pseudoaneurysm is a rare complication of chronic pancreatitis (CP), all pancreatic or peripancreatic arteries have been reported to be involved, while hepatic artery is less common.

PATIENT CONCERNS

This case report illustrated a 42-year-old man with CP who developed right hepatic artery pseudoaneurysm (HAP), and finally he was treated with intravascular embolization.

DIAGNOSES

The patient suffered from HAP due to acute attack of CP.

INTERVENTIONS

The pseudoaneurysm located in a fine branch of right hepatic artery was embolized.

OUTCOMES

The HAP of the patient was cured. He had no recurrent bloody stool or abdominal pain. The symptoms gradually relieved.

CONCLUSION

Herein, we report a patient with CP who developed right HAP causing infected hematoma, gastrointestinal bleeding, and obstructive jaundice, and a literature review is also presented. HAP caused by CP is a rare disease in the clinic, but rupture of pseudoaneurysm is fatal. Careful evaluation, early detection, and prompt treatment should be performed when the patient is admitted and followed up.

Outcome of surgery for chronic pancreatitis related pancreatic ascites and pancreatic pleural effusion

BACKGROUND

An internal pancreatic fistula involves an abnormality in the way that the pancreas communicates with organs and spaces within the body. This is usually due to a disrupted pancreatic duct or psuedocyst leakage (Ascitic or pleural fluid amylase level >1000 S units/dl and fluid protein level >3 g/dl). The study aims to report our experience with surgery for chronic pancreatitis-related pancreatic ascites and pancreatic pleural effusions.

METHODS

All the patients, who underwent surgical intervention for pancreatic ascites and pancreatic pleural effusion between August 2007 and December 2020 in the Department of Surgical gastroenterology, Institute of Postgraduate Medical Education and Research, Kolkata, India were retrospectively reviewed.

RESULTS

Of the total 14 patients, 10 (71.4%) were men with a median age of 40 (4-49) years. The median interval between onset of symptoms of CP and diagnosis of IPF was 27 (3-60) months. All patients had a history of chronic abdominal pain and 5 (35.7%) had a prior history of hospitalization for pain. Eleven patients (78.5%) presented with abdominal distension and 3 (21.4%) patients had respiratory distress. Six (42.8%) patients had undergone endotherapy before surgery. Contrast-enhanced computed tomography detected pancreatic pseudocyst in 10 (71.42%) patients. The most commonly performed operation was lateral pancreaticojejunostomy (n = 11, 78.5%). Seven postoperative complications developed in 4 (28.5%) patients. After a median follow-up of 60 (6-86) months, no patient developed recurrence of pancreatic ascites or pleural effusion.

CONCLUSION

In the experienced hand, surgery can be performed with acceptable perioperative morbidity and mortality and long-term satisfactory outcomes.