Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2006 Jan 11:6:3.
doi: 10.1186/1471-230X-6-3.

Management and outcome of bleeding pseudoaneurysm associated with chronic pancreatitis

Jun-Te Hsu  1 , Chun-Nan Yeh, Chien-Fu Hung, Han-Ming Chen, Tsann-Long Hwang, Yi-Yin Jan, Miin-Fu Chen
Affiliations

Management and outcome of bleeding pseudoaneurysm associated with chronic pancreatitis

Jun-Te Hsu et al. BMC Gastroenterol. .

Abstract

Background: A bleeding pseudoaneurysm in patients with chronic pancreatitis is a rare and potentially lethal complication. Optimal treatment of bleeding peripancreatic pseudoaneurysm remains controversial. This study reports on experience at Chang Gung Memorial Hospital (CGMH) in managing of bleeding pseudoaneurysms associated with chronic pancreatitis.

Methods: The medical records of 9 patients (8 males and 1 female; age range, 28-71 years; median, 36 years) with bleeding pseudoaneurysms associated with chronic pancreatitis treated at CGMH between Aug. 1992 and Sep. 2004 were retrospectively reviewed. Alcohol abuse (n = 7;78%) was the predominant predisposing factor. Diagnoses of bleeding pseudoaneurysms were based on angiographic (7/7), computed tomographic (4/7), ultrasound (2/5), and surgical (2/2) findings. Whether surgery or angiographic embolization was performed was primarily based on patient clinical condition. Median follow-up was 38 months (range, 4-87 months).

Results: Abdominal computed tomography revealed bleeding pseudoaneurysms in 4 of 7 patients (57%). Angiography determined correct diagnosis in 7 patients (7/7, 100%). The splenic artery was involved in 5 cases, the pancreaticoduodenal artery in 2, the gastroduodenal artery in 1, and the middle colic artery in 1. Initial treatment was emergency (n = 4) or elective (n = 3) surgery in 7 patients and arterial embolization in 2. Rebleeding was detected after initial treatment in 3 patients. Overall, 5 arterial embolizations and 9 surgical interventions were performed; the respective rates of success of these treatments were 20% (1/5) and 89% (8/9). Five patients developed pseudocysts before treatment (n = 3) or following intervention (n = 2). Pseudocyst formation was identified in 2 of the 3 rebleeding patients. Five patients underwent surgical treatment for associated pseudocysts and bleeding did not recur. One patient died from angiography-related complications. Overall mortality rate was 11% (1/9). Surgery-related mortality was 0%.

Conclusion: Angiography is valuable in localizing bleeding pseudoaneurysms. In this limited series, patients with bleeding pseudoaneurysms associated with chronic pancreatitis treated surgically seemingly obtained good outcomes.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Celiac angiography from case 5 shows a smooth saccular outpouching at the distal gastroduodenal artery, compatible with a pseudoaneurysm.
Figure 2
Figure 2
Flow chart showing management and outcome in relation to bleeding pseudoaneurysm treatment.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Balachandra S, Siriwardena AK. Systemic appraisal of the management of the major vascular complications of pancreatitis. Am J Surg. 2005;190:489–495. doi: 10.1016/j.amjsurg.2005.03.009. - DOI - PubMed
    1. Gambiez LP, Ernst OJ, Merlier OA, Porte HL, Chambon JPM, Quandalle PA. Arterial embolization for bleeding pseudocysts complicating chronic pancreatitis. Arch Surg. 1997;132:1016–1021. - PubMed
    1. Beattie GC, Hardman JG, Redhead D, Siriwardena AK. Evidence for a central role for selective mesenteric angiography in the management of the major vascular complications of pancreatitis. Am J Surg. 2003;185:96–102. doi: 10.1016/S0002-9610(02)01199-6. - DOI - PubMed
    1. Bergert H, Hinterseher I, Kersting S, Leonhardt J, Bloomenthal A, Saeger HD. Management and outcome of hemorrhage due to arterial pseudoaneurysms in pancreatitis. Surgery. 2005;137:323–328. doi: 10.1016/j.surg.2004.10.009. - DOI - PubMed
    1. Bresler L, Boissel P, Grosdidier J. Major hemorrhage from pseudocysts and pseudoaneurysms caused chronic pancreatitis: surgical therapy. World J Surg. 1991;15:649–653. doi: 10.1007/BF01789217. - DOI - PubMed

MeSH terms