Cureus. 2021 May 01;13(5):e14789. doi: 10.7759/cureus.14789.

An Undiagnosed Case of Chronic Pancreatitis With Multiple Visceral Arteries Pseudoaneurysm.

Cureus

Muhammad Naveed Anwar, Nouman Anthony, Qazi Kamran Amin, Zaland A Yousafzai, Hira Khalil

PMID: 34094751 PMCID: PMC8169010 DOI: 10.7759/cureus.14789

Abstract

Visceral artery aneurysms, which could be either true or pseudo, are abnormal focal dilations of vessels supplying the abdominal organs. True aneurysms, by definition, suggest dilation of the vessel in response to increased blood flow, ultimately causing a blood-filled sac to form. Pseudoaneurysm, however, is the pooling of blood in surrounding tissues secondary to trauma or rupture. A 43-year-old woman G9 P9, known hypertensive was admitted electively for investigation of melena, hematemesis, hematochezia for one week along with weight loss and epigastric pain. Laboratory studies showed mild anemia with a hemoglobin level of 9.6 g/dL, hematocrit 29.5%, mean corpuscular hemoglobin (MCH) 26.7, upon which she was transfused two pints of blood and commenced at Injectable Vitamin K, injectable transamine, and infusion omeprazole. Two days later her levels improved to HB 12.4 g/dL, hematocrit 37.5%, MCH 26.7 pg, RBC 4.64 × 10*12/L. while being on treatment, a computed tomography (CT) mesenteric angiography was also conducted that showed multiple splanchnic pseudoaneurysms involving celiac axis trifurcation, gastroduodenal artery, superior/inferior pancreaticoduodenal artery, and jejunoileal branch of the superior mesenteric artery, and a large partially thrombosed pseudoaneurysm arising from superior pancreaticoduodenal branch causing significant mass effect on the second part of duodenum. On the basis of such findings, it was advised to perform coiling and embolization of the corresponding arteries. Multiple other small aneurysms with secondary arteriovenous malformations (AVM) were also seen. The whole circuit of flow retrograde and antegrade along with the aneurysm sac was blocked with multiple coils of variable sizes. An angiogram was repeated that revealed a good outcome. Pseudoaneurysms of the visceral arteries are very rare and affect mainly the splenic artery. The rarest of which is gastroduodenal artery (1.5%), pancreaticoduodenal artery (2%), and coeliac truck (4%). Therefore, this can be an incidental finding. The diagnosis is usually made with an angiography combined with clinical presentation. Variable treatment options are available depending on the patient's fitness and hemodynamic stability. The endovascular approach, however, is mostly used in such cases.

Copyright © 2021, Anwar et al.

Keywords: celiac axis trifurcation pseudo aneurysm; ethylene-vinyl alcohol copolymer; false aneurysm; gastro-duodenal artery pseudo aneurysm; peptide hydrolases; pseudo aneurysm in jejunoileal branch of superior mesenteric artery; splanchnic artery pseudo aneurysm coiling and embolization; splanchnic pseudo aneurysms; thrombosed pseudo aneurysm of superior pancreaticoduodenal artery; trisacryl gelatin microspheres

Conflict of interest statement

References

1. Semin Intervent Radiol. 2008 Sep;25(3):204-15 - PubMed
2. Radiographics. 2006 Nov-Dec;26(6):1687-704; quiz 1687 - PubMed
3. BMJ Case Rep. 2018 Apr 11;2018: - PubMed
4. Acta Med Port. 2017 Sep 29;30(9):658-661 - PubMed
5. J Med Case Rep. 2017 May 4;11(1):126 - PubMed
6. Eur Radiol. 2015 Jul;25(7):2004-14 - PubMed
7. Ann Vasc Surg. 2010 Nov;24(8):1136.e7-11 - PubMed
8. Clin Kidney J. 2015 Aug;8(4):363-7 - PubMed
9. BMJ Case Rep. 2017 Apr 26;2017: - PubMed
10. Ann Vasc Surg. 2011 Oct;25(7):981.e7-11 - PubMed
11. Ann Vasc Surg. 2004 Nov;18(6):695-703 - PubMed
12. Ann Surg Innov Res. 2013 Apr 16;7(1):4 - PubMed
13. Tech Vasc Interv Radiol. 2015 Mar;18(1):14-23 - PubMed
14. Ann Vasc Surg. 1992 Mar;6(2):171-2 - PubMed
15. J Vasc Surg. 1986 May;3(5):836-40 - PubMed

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