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Case Reports
. 2022 Jul 12;15(7):e248946.
doi: 10.1136/bcr-2022-248946.

Placement of a flow diverter-like stent together with coil embolisation for treatment of pancreatic pseudoaneurysm involving the origin of the gastroduodenal artery

Sameet Patel  1 , Sanjay Chandnani  2 , Avinash Gutte  3 , Pravin M Rathi  2
Affiliations
Case Reports

Placement of a flow diverter-like stent together with coil embolisation for treatment of pancreatic pseudoaneurysm involving the origin of the gastroduodenal artery

Sameet Patel et al. BMJ Case Rep. .

Abstract

A pancreatic pseudoaneurysm can occur following an attack of pancreatitis. This occurs due to erosion of the pancreatic or peripancreatic artery by the pancreatic enzyme-rich pancreatic secretion pseudocyst. If left untreated, it may cause massive and even fatal haemorrhage. Interventional radiology with coil embolisation of the pseudoaneurysm is the standard of care in such cases. We describe a patient who developed a pseudoaneurysm involving the origin of the gastroduodenal artery (GDA). This was successfully managed by coil embolisation of the pseudoaneurysm along with placement of a flow diverter-like stent in the common hepatic artery across the origin of the GDA leading to exclusion of the diseased segment.

Keywords: Gastroenterology; Interventional radiology; Pancreatitis.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
CT of the Abdomen done initially showing a large (7.9x8.2x7.3 cm) heterogenous, well-defined partially thrombosed pseudoaneurysm, posterior to the head and neck of the pancreas with compression on distal common bile duct with intrahepatic biliary radical dilatation with the pancreas showing changes of atrophy, calcific foci in the head and dilated pancreatic duct. (A) Plain study, (B) Arterial phase, (C) Portal phase, (D) Venous phase.
Figure 2
Figure 2
Repeat CT of the abdomen on Day 10 shows large thrombosed pseudoaneurysm arising from the gastroduodenal artery (GDA) (Size- 9.8x8.9x9.8cm) with multiple hyperdense coils in the pseudoaneurysm. Stent is seen in the common hepatic artery (CHA), across the origin of the GDA. The CHA is dilated. Common bile duct is dilated with IHBRD and dilated main pancreatic duct. (A) Plain study, (B) Arterial phase, (C) Portal phase, (D) Venous phase.
Figure 3
Figure 3
Repeat CT of the abdomen done at 4 months shows common hepatic artery stent and coils in situ and regression of the pseudoaneurysm. (A) Plain study, (B) Arterial phase, (C) Portal phase, (D) Venous phase.
Figure 4
Figure 4
Diagrammatic representation of various pseudoaneurysms in relation to the pancreas (illustrated by authors SC and SP).IVC; inferior vena cava.
See this image and copyright information in PMC

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