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J Gastroenterol Hepatol 2022 Jun 27. Epub 2022 Jun 27.

Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.

Surg Case Rep 2022 Jun 14;8(1):111. Epub 2022 Jun 14.

Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22, Showa-machi, Maebashi, Gunma, Japan.

Background: Although visceral aneurysms are relatively rare, it can be life-threatening in case it ruptures. We report a case of Mirizzi syndrome accompanied by a pseudoaneurysm that ruptured into the gallbladder.

Case Presentation: The patient was a 73-year-old woman with persistent gastrointestinal bleeding and progressive jaundice. Read More

J Clin Med 2022 May 24;11(11). Epub 2022 May 24.

Interventional Radiology Unit, Department of Radiology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy.

Visceral artery pseudoaneurysms (VAPAs) are the most frequently diagnosed pseudoaneurysms (PSAs). PSAs can be asymptomatic or symptomatic. The aim of our study was to evaluate the safety and effectiveness of percutaneous embolization of VAPAs performed on patients with an unfeasible trans-arterial approach. Read More

Radiol Case Rep 2022 Aug 29;17(8):2668-2672. Epub 2022 May 29.

Gastroenterology Unit, Azienda Ospedaliera, Via Migliori 1, Cosenza 87100, Italy.

Visceral arterial pseudoaneurysms are uncommon vascular abnormalities affecting renal or splanchnic arteries. They can be complications of chronic pancreatitis, blunt or penetrating abdominal trauma, or surgical, endoscopic and interventional radiological procedures. Visceral arterial pseudoaneurysms can be life-threatening because of hemorrhagic shock secondary to rupture and massive bleeding. Read More

Dig Endosc 2022 May 23. Epub 2022 May 23.

Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-, Cesena, Italy.

Objectives: To generate a prognostic model based on a nomogram for adverse events (AEs) prediction after lumen-apposing metal stents (LAMS) placement in patients with pancreatic fluid collections (PFC).

Methods: Data from a large multicenter series of PFCs treated with LAMS placement were retrieved. AE (overall and excluding mild events) prediction was calculated through a logistic regression model and a nomogram was created and internally validated after bootstrapping. Read More

Cureus 2022 Apr 7;14(4):e23934. Epub 2022 Apr 7.

Internal Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND.

Hemosuccus pancreaticus (HP) is a rare cause of upper gastrointestinal bleeding caused by bleeding from the ampulla of Vater into the duodenum. HP most commonly results from a rupture of pseudoaneurysms secondary to chronic pancreatitis. The low incidence of HP and the wide spectrum of its clinical presentation poses diagnostic challenges. Read More

J Int Med Res 2022 May;50(5):3000605221098179

Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, Belgrade, Serbia.

Clinical manifestations of Covid-19 vary widely among patients. Recent studies suggest that up to 15% of patients with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections develop gastrointestinal symptoms. The location of virus-host cell receptors angiotensin-converting enzyme 2 and transmembrane serine protease 2 has an important role in the pathophysiology and presentation of disease. Read More

Chin J Traumatol 2022 Apr 13. Epub 2022 Apr 13.

Haepato-Biliary-Pancreatic Unit, Hammersmith Hospital. Imperial College, London, W120TS, UK.

Purpose: Liver is the most frequently injured organ in abdominal trauma. Today non-operative management (NOM) is considered as the standard of care in hemodynamically stable patients, with or without the adjunct of angioembolisation (AE). This systematic review assesses the incidence of complications in patients who sustained liver injuries and were treated with simple clinical observation. Read More

Surg Case Rep 2022 Apr 24;8(1):74. Epub 2022 Apr 24.

Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, Japan.

Background: Necrotizing fasciitis after pancreaticoduodenectomy (PD) has never been reported. We experienced a case of necrotizing fasciitis caused by pseudoaneurysmal hemorrhage after PD.

Case Presentation: A 72-year-old male was diagnosed with cholangiocarcinoma and underwent PD. Read More

Bratisl Lek Listy 2022 ;123(5):357-361

Pseudoaneurysm of the splenic vein is a rare entity which is associated with pancreatitis in 52 % cases. Pseudocysts of the pancreas create approximately 70 % of all cystic lesions of the pancreas. One of the most dangerous complications of pancreatic pseudocysts is bleeding into the cystic lumen. Read More

Chirurgia (Bucur) 2021 Dec;116(6 Suppl):S5-S15

Beside the common situations of upper gastrointestinal bleeding (GIB) managed by endoscopy, there are clinical situations when the endoscopic approach is limited by the amount of blood, the hemodynamic instability, the intermittent nature of bleeding and a proper diagnosis and treatment requires radiological interventional methods and even surgery. The pancreatic pathology is rarely considered as a possible cause for patients that presents in emergencies with GIB. The rupture of visceral artery aneurysms (VAAs), without underlying pancreatic pathology, should also be regarded in the differential diagnosis of GIB. Read More

Cureus 2022 Jan 31;14(1):e21780. Epub 2022 Jan 31.

Gastroenterology and Hepatology, Rutgers University New Jersey Medical School, Newark, USA.

Pancreatitis is commonly seen with alcohol use and gallstones, but it can be a post-procedural complication from endoscopic retrograde cholangiopancreatography (ERCP). Inflammation of the pancreas can lead to pseudoaneurysm formation, which is rare but extremely dangerous if ruptures, with high mortality and morbidity. Sickle cell disease can also cause vascular injury from repeated vaso-occlusion, inflammation, and ischemia. Read More

J Int Med Res 2022 Feb;50(2):3000605221083441

Clinic for Digestive Surgery, University Clinical Centre of Serbia, Dr Koste Todorovica No. 6, Belgrade 11000, Serbia.

A pancreatic pseudoaneurysm is a rare but life-threatening clinical entity. Prompt diagnosis and appropriate treatment are of great clinical importance. We herein present an unusual case of a pseudoaneurysm of the posterior inferior pancreaticoduodenal artery that developed as a complication of chronic pancreatitis. Read More

J Vasc Interv Radiol 2022 03;33(3):304-307

Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

The utility of occluding the bleeding artery using an occlusion balloon catheter during stent-graft placement for visceral artery bleeding was evaluated. Stent-graft placement for visceral artery bleeding was performed using a balloon catheter in 6 patients. All bleeding occurred after biliary or pancreatic surgery. Read More

Anticancer Res 2022 Mar;42(3):1579-1588

Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.

Background/aim: Management strategies for pseudoaneurysm rupture after pancreatic resection have not yet been firmly established due to its low incidence and effects of environmental variability among centers. This study aimed to provide a basis for treatment strategy improvement.

Patients And Methods: Clinical features and outcomes of 29 patients who experienced pseudoaneurysm formation or rupture following pancreatic resection were retrospectively reviewed. Read More

Radiol Case Rep 2022 Mar 23;17(3):1013-1020. Epub 2022 Jan 23.

Department of Radiology, Robert Larner M.D. College of Medicine, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401, USA.

Pancreatic pseudocyst formation, arterial pseudoaneurysm, and splanchnic vein thrombosis are complications of chronic pancreatitis that account for significant morbidity and mortality in this patient population. While the short-term utility of timely endovascular intervention for treating the vascular complications of chronic pancreatitis have been relatively well documented, there is a paucity of longitudinal follow-up in this patient population, therefore making it difficult to predict the long-term efficacy of these interventions. This report details a case of a gastroduodenal artery pseudoaneurysm embolization followed by symptomatic superior mesenteric vein chronic thrombosis treated by stent dilatation in a patient with chronic pancreatitis, with 7 years clinical and imaging follow-up. Read More

J Vasc Surg 2022 05 24;75(5):1634-1642.e1. Epub 2022 Jan 24.

Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pa.

Introduction: True pancreaticoduodenal artery aneurysms (PDAAs) are rare, and prior reports often fail to distinguish true aneurysms from pseudoaneuryms. We sought to characterize all patients who presented to our health system from 2004 to 2019 with true PDAAs, with a focus on risk factors, interventions, and patient outcomes.

Methods: Patients were identified by querying a single health system picture archiving and communication system database for radiographic reports noting a PDAA. Read More

World J Surg 2022 05 27;46(5):1161-1171. Epub 2022 Jan 27.

Department of Surgery, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA.

Background: Delayed bleeding after pancreaticoduodenectomy (PD) is a life-threatening complication. However, the optimal management remains unclear. We summarize our experience of the management of delayed bleeding after PD and define the outcomes associated with different types of management. Read More

J Hepatobiliary Pancreat Sci 2022 May 2;29(5):e41-e43. Epub 2022 Feb 2.

Department of Diagnostic Radiology, Nagano Red Cross Hospital, Nagano, Japan.

Highlight Endovascular pseudoaneurysm repair with a stent graft enables aneurysm treatment and vessel preservation; however, little is known about its complications. Sano and colleagues describe a case of massive intestinal bleeding associated with stent-graft migration. They used a multidisciplinary approach with endoscopic hemostasis and endovascular embolization to overcome this unprecedented difficulty. Read More

J Investig Med High Impact Case Rep 2022 Jan-Dec;10:23247096211070388

University of Missouri School of Medicine, Columbia, MO, USA.

Hemosuccus pancreaticus is a rare but potentially torrential and life-threatening cause of acute upper gastrointestinal bleeding. It is described as an intermittent hemorrhage from the major duodenal papilla via the main pancreatic duct. Peripancreatic pseudoaneurysm following chronic pancreatitis is a common underlying etiology. Read More

ACG Case Rep J 2022 Jan 10;9(1):e00739. Epub 2022 Jan 10.

Department of Radiology, University of Louisville, Louisville, KY.

Hemosuccus pancreaticus is a life-threatening but rare cause of intermittent upper gastrointestinal bleeding caused by acute/subacute hemorrhage into a pancreatic duct or pancreatic pseudocyst because of a ruptured pseudoaneurysm. This entity is described in patients with pseudoaneurysms that develop in the context of severe pancreatic/peripancreatic inflammatory changes. Hemosuccus pancreaticus presents a difficult diagnostic and therapeutic conundrum because it tends to involve inflamed, friable, and tortuous vascular pathways. Read More

Cureus 2021 Dec 8;13(12):e20275. Epub 2021 Dec 8.

Department of Gastrointestinal and General Surgery, Kathmandu Medical College Teaching Hospital, Kathmandu, NPL.

Introduction The advent of neoadjuvant therapy in the management of pancreatic adenocarcinoma has significantly improved the prognosis of the disease. Nevertheless, the only chance of long-term disease-free survival in pancreatic cancer is achieved with complete tumor resection, and artery involvement by the tumor is one of the major determinants in its resectability. We aim to evaluate the feasibility of a novel technique, namely, the periarterial divestment, which has allowed surgeons to clear the tumor tissues off the visceral arteries without the need for arterial reconstruction. Read More

Updates Surg 2021 Nov 23. Epub 2021 Nov 23.

Department of Gastroenterology, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India.

Background: Bleeding pseudoaneurysm (PSA) is a rare but potentially lethal complication of chronic pancreatitis (CP). It requires expeditious management by a multidisciplinary team. The study aims to report our experience with PSA in the background of CP. Read More

In Vivo 2021 Nov-Dec;35(6):3521-3526

Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan.

Background/aim: Auto-activation positron emission tomography (AAPET) is one of the most promising methods to verify beam range in carbon ion radiotherapy (C-ion RT). We aimed to confirm this for the first time in a clinical setting by performing AAPET in a patient with pancreatic cancer previously receiving coil embolisation of hepatic artery pseudoaneurysm.

Materials And Methods: A 70-year-old pancreatic head cancer patient was treated with C-ion RT on a clinical dose of 4. Read More

ACG Case Rep J 2021 Sep 5;8(9):e00663. Epub 2021 Oct 5.

Department of Gastroenterology, Baylor Scott and White Medical Center Temple, Temple, TX.

Gastroduodenal artery (GDA) pseudoaneurysms are rare clinical entities that typically develop in the setting of chronic inflammation of the pancreas, although idiopathic pseudoaneurysms can occur. Although GDA pseudoaneurysms carry the risk of rupture with resultant hemorrhage, they seldom are reported to cause biliary obstruction. We report a unique case of biliary obstruction secondary to extrinsic compression of the bile duct by a GDA pseudoaneurysm successfully managed by nonoperative means. Read More

Pol J Radiol 2021 18;86:e489-e495. Epub 2021 Aug 18.

Department of Vascular and Interventional Radiology, AORN "A. Cardarelli", Napoli, Italy.

Pseudoaneurysms of the pancreatic and peripancreatic arteries is a well-known complication of chronic or necrotizing pancreatitis due to proteolytic enzymatic digestion of the arterial wall. A major part of peripancreatic pseudoaneurysms involve the splenic artery, but any peripancreatic artery may be involved and bleed. They are potentially life threatening for patients, due to spontaneous intraperitoneal rupture, rupture and fistulization into the surrounding organs, or fistulization into the pancreatic duct. Read More

Am J Forensic Med Pathol 2022 Mar;43(1):76-80

From the Volusia County Medical Examiner's Office, Daytona Beach, FL.

Abstract: This case report describes fatal exsanguination due to splenic artery hemorrhage into a pancreatic pseudocyst with cystogastrostomy in a 46-year-old woman. The decedent had a complicated medical history including necrotizing pancreatitis, giant pseudocyst formation after cystogastrostomy procedure, and coiling of a hemorrhagic splenic artery. While hospitalized, she underwent embolization of a ruptured splenic artery pseudoaneurysm. Read More

ANZ J Surg 2022 04 21;92(4):915-917. Epub 2021 Sep 21.

Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore.

J Clin Med 2021 Aug 21;10(16). Epub 2021 Aug 21.

Department of Upper Abdominal Diseases, Karolinska University Hospital, 141 86 Stockholm, Sweden.

Introduction: Chronic pancreatitis (CP) is a long-standing progressive inflammation of the pancreas, which can lead to a variety of vascular complications, such as splanchnic venous thrombosis (VT) and arterial pseudoaneurysm (PA). There is a lack of studies on vascular complications in Scandinavian countries.

Methods: We performed a retrospective analysis of medical records of patients with CP identified from the Karolinska University Hospital database between 2003 and 2018. Read More

Ann Hepatobiliary Pancreat Surg 2021 Aug;25(3):426-430

Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Italy.

Portal vein arterialization (PVA) has been attracting attention for its role as a salvage inflow technique in various clinical applications. Initially performed in shunt surgery for portal hypertension, with the aim of preventing a decreased hepatic inflow, it is largely used in case of hepatic artery thrombosis in the transplantation domain or in the enlarged radical operations in case of hilar cancer invading the hepatic artery. A 62-year-old man underwent a left extended hepatectomy with hepatic bile duct resection and right Roux-en-Y hepaticojejunostomy for hilar cholangiocarcinoma. Read More