Multidisciplinary approach to pseudoaneurysms complicating pancreatic pseudocysts. Impact of pretreatment diagnosis

Abstract

Objective: To determine the effectiveness of thin-section, dynamic-contrast computed tomography and angiography in detecting the presence of pancreatic pseudoaneurysms.

Design: This case series consisted of 57 patients who were being examined for endoscopic drainage of pancreatic pseudocysts.

Setting: All patients were examined in a tertiary care, teaching hospital.

Patients: Fifty-seven consecutive patients were examined for 2 years. Follow-up ranged from 6 months to 2 years.

Interventions: All patients underwent thin-section, high-speed, dynamic-contrast computed tomography. Those patients with findings that were consistent with the presence of a pseudoaneurysm underwent angiography. Embolization was attempted if a pseudoaneurysm was present. Endoscopic retrograde cholangiopancreatography was used to determine pancreatic ductal anatomy before operation.

Main outcome measure: No undetected pseudoaneurysm has complicated this series of endoscopically drained pseudocysts.

Results: Five patients had findings that were consistent with a pancreatic pseudoaneurysm on computed tomography. Angiographic findings confirmed a pseudoaneurysm in four patients, and angiographic embolization was successful in three. Four patients underwent resection, while one was treated with embolization and endoscopic stenting of a compressed pancreatic duct. There were no mortalities.

Conclusions: Before endoscopic drainage of a pancreatic pseudocyst, a thin-section, high-speed, dynamic-contrast computed tomographic scan is essential. If there are findings consistent with the development of a pseudoaneurysm, angiography must be performed. This allows delineation of the arterial anatomy, as well as the option of performing angiographic embolization. While patients with pseudoaneurysms in the body and tail of the pancreas underwent resection, angiographic embolization alone was an acceptable alternative when the lesion was located in the head of the pancreas.