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Case Rep Gastrointest Med 2021 5;2021:5550005. Epub 2021 May 5.

Department of Hospital Medicine, Northeast Georgia Health System, Gainesville, GA, USA.

. Pancreatic pseudoaneurysm is a rare but potentially fatal complication that can follow pancreatitis. While early detection is critical to preventing poor long-term outcomes, clinical features vary significantly. Read More

World J Hepatol 2021 Apr;13(4):483-503

Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan.

Background: Although arterial hemorrhage after pancreaticoduodenectomy (PD) is not frequent, it is fatal. Arterial hemorrhage is caused by pseudoaneurysm rupture, and the gastroduodenal artery stump and hepatic artery (HA) are frequent culprit vessels. Diagnostic procedures and imaging modalities are associated with certain difficulties. Read More

Radiologe 2021 Jun 3;61(6):555-562. Epub 2021 May 3.

Abteilung für Diagnostische und Interventionelle Radiologie, Sana Klinikum Hof GmbH, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität Erlangen-Nürnberg, Eppenreuther Straße 9, 95032, Hof/Saale, Deutschland.

Approximately 20% of patients with acute pancreatitis develop complications that require surgical or radiological intervention. Radiology plays a central role, not only for imaging (course of the disease, detection of superinfection and their related complications, and development of necrosis) but also for the treatment of vascular and nonvascular complications. In the treatment of severe or necrotizing pancreatitis, a multidisciplinary staged approach with minimally invasive therapies such as endoscopic or percutaneous drainage should be used. Read More

Int J Surg Case Rep 2021 Apr 23;81:105816. Epub 2021 Mar 23.

Department of Gastrointestinal and General Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Electronic address:

Introduction And Importance: Common Hepatic Artery (CHA) Pseudoaneurysm is a rare entity, attributed to infections, trauma, and upper abdominal surgery. Most cases occur after biliary and pancreatic surgery. CHA pseudoaneurysm after total gastrectomy is uncommon and can be devastating. Read More

Ochsner J 2021 ;21(1):104-107

Department of Surgery, Ridley-Tree Cancer Center, Santa Barbara, CA.

Visceral artery aneurysms and pseudoaneurysms are uncommon phenomena with a high mortality rate in cases of rupture. These rare vascular pathologies are usually asymptomatic and are therefore generally discovered incidentally on computed tomography or magnetic resonance imaging examination. Current therapeutic options have trended toward a minimally invasive approach because of evolving endovascular treatment options, with open operations typically reserved for cases of intraabdominal hemorrhage. Read More

Vasc Endovascular Surg 2021 Mar 19:15385744211002497. Epub 2021 Mar 19.

Division of GI & HPB Surgery, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India.

Pancreatic pseudoaneurysms though uncommon can result in life-threatening spontaneous acute gastrointestinal or intraperitoneal hemorrhage. Celiac artery pseudoaneurysm in a background of chronic pancreatitis is a very rare event. Digital Subtraction Angiography is an important adjunct in the diagnosis and follow-up with the advantage of providing therapeutic options along with giving other details regarding the site, size, and flow characteristics. Read More

BMJ Case Rep 2021 Mar 10;14(3). Epub 2021 Mar 10.

Department of Surgical Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

We report a case of walled off pancreatic necrosis in a patient with alcoholic pancreatitis who underwent endoscopic ultrasound-guided multiple pigtail catheter drainage. 10 days later patient presented with massive haemorrhage likely due to erosion of portal vein pseudoaneurysm caused by decubitus of pigtails. Patient required emergent portal venorrhaphy to arrest haemorrhage. Read More

BMJ Case Rep 2021 Mar 4;14(3). Epub 2021 Mar 4.

HPB Surgery, Royal Blackburn Hospital, Blackburn, Lancashire, UK.

Splenic artery pseudoaneurysm (SAP) is a rare and dangerous diagnosis with a high risk of rupture and death. It is the most common cause of main pancreatic duct haematoma-haematosuccus pancreaticus (HP). Neither SAP nor HP have specific clinical features that allow diagnosis without cross-sectional imaging. Read More

Surg Endosc 2021 Mar 3. Epub 2021 Mar 3.

Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain.

Background And Aims: Endoscopic necrosectomy through lumen apposition metal stents (LAMS) is increasingly being used for complicated walled-off pancreatic necrosis (WOPN), but the need for necrosectomy after stent placement is not well understood. The aim of this study was to evaluate clinical, endoscopic, and radiologic predictors of the need for necrosectomy in patients treated with LAMS.

Methods: We retrospectively reviewed patients with WOPN treated with LAMS from 2014 to 2017. Read More

Surgery 2021 Jun 19;169(6):1446-1453. Epub 2021 Feb 19.

Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Electronic address:

Background: Although postoperative pancreatic fistula (POPF) is a common and critical complication of pancreatoduodenectomy (PD), effective strategies to prevent POPF have not yet been completely developed. Because appropriate management of POPF is important to reduce the mortality rate after PD, in this study we aimed to evaluate our approach for the management of POPF after PD, including the postoperative course.

Methods: This retrospective study included 605 consecutive patients who underwent PD at our hospital between 2010 and 2020. Read More

World J Clin Cases 2021 Jan;9(2):389-395

Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China.

Background: Pancreatic pseudocyst may cause serious gastrointestinal complications including necrosis, infection, and perforation of the gastrointestinal tract wall, but massive gastric bleeding is very rare.

Case: We report a rare case of a 49-year-old man with life-threatening gastric bleeding from a pseudoaneurysm of the splenic artery perforating the stomach induced by pancreatic pseudocyst. During hospitalization, gastroscopy revealed a bare blood vessel in an ulcer-like depression of the greater gastric curvature, and computed tomography scan confirmed a pancreatic pseudocyst invading part of the spleen and gastric wall of the greater curvature. Read More

World J Clin Cases 2021 Jan;9(1):236-244

Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China.

Background: Hemosuccus pancreaticus is a very rare but severe form of upper gastrointestinal hemorrhage. The most common etiology is peripancreatic pseudoaneurysm secondary to chronic pancreatitis. Due to the rarity of gastroduodenal artery pseudoaneurysms, most of the current literature consists of case reports. Read More

Gan To Kagaku Ryoho 2020 Dec;47(13):2159-2161

Dept. of Surgery, Matsusaka Municipal Hospital.

The patient was a 76-year-old woman who was referred to our department for jaundice. From further evaluation, resectable cancer of the pancreas head was diagnosed. The patient did not want to undergo surgery, although it had been planned. Read More

Dig Dis Sci 2021 02 19;66(2):420-423. Epub 2021 Jan 19.

Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, 1 University of New Mexico, MSC 10-5550, Albuquerque, NM, 87131, USA.

World J Transplant 2020 Dec;10(12):404-414

Hepato-Pancreatico-Biliary Surgery and Transplant Unit, La Fe University Hospital, Valencia 46026, Spain.

To summarize the long-term complications after pancreas transplantation that affect graft function, a literature search was carried out on the long-term complications of pancreatic transplantation, namely, complications from postoperative 3 mo onwards, in terms of loss of graft function, late infection and vascular complications as pseudoaneurysms. The most relevant reviews and studies were selected to obtain the current evidence on these topics. The definition of graft failure varies among different studies, so it is difficult to evaluate, a standardized definition is of utmost importance to know the magnitude of the problem in all worldwide series. Read More

Langenbecks Arch Surg 2021 Jan 3. Epub 2021 Jan 3.

Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan.

Purpose: Pseudoaneurysm (PA) after pancreaticoduodenectomy (PD) is a harmful complication due to postoperative pancreatic fistula. However, the preventive method for PA is unclear. This study aimed to assess the risk factors for PA after PD and to evaluate the clinical features of patients with PA. Read More

Pancreatology 2021 Jan 1;21(1):263-268. Epub 2020 Dec 1.

Department of Surgery, Division of Hepato-biliary-pancreatic Surgery and Transplantation, Kyoto University, Japan.

Background: /Objectives: This study aimed to elucidate the efficacy of CT findings and perioperative characteristics to predict post-pancreatectomy hemorrhage (PPH): a critical complication after pancreaticoduodenectomy.

Methods: The records of 590 consecutive patients who underwent pancreaticoduodenectomy at three institutes between 2012 and 2018 were included. The presence of a vascular wall abnormality or ascites with high density (vascular abnormality) on postoperative day (POD) 5-10 contrast-enhanced CT (early CT), perioperative characteristics, and any PPH or pseudoaneurysm formation (PPH events) were analyzed through a multivariate analysis. Read More

Clin Radiol 2021 Apr 14;76(4):314.e9-314.e15. Epub 2020 Dec 14.

Department of Radiology and Research Institute of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Aim: To evaluate the safety and efficacy of transarterial embolisation (TAE) of dorsal pancreatic artery (DPA) haemorrhage.

Materials And Methods: Nineteen consecutive patients (M:F = 16:3, mean age 59.6 years) who underwent TAE of DPA in three tertiary medical centres between January 2001 to January 2020 were reviewed retrospectively. Read More

J Clin Imaging Sci 2020 11;10:72. Epub 2020 Nov 11.

Department of Radiology, Nassau University Medical Center, East Meadow, New York, United States.

We present a case of a 69-year-old female who arrived in hemorrhagic shock with symptoms of upper gastrointestinal bleeding. Imaging on admission was diagnostic of a large splenic artery pseudoaneurysm, which was presumed to have bled into the pancreatic duct given clinical symptoms of upper gastrointestinal bleeding. The pseudoaneurysm was successfully treated with coil embolization resulting in resolution of clinical symptoms. Read More

Rev Esp Enferm Dig 2020 Dec 3. Epub 2020 Dec 3.

Radiodiagnóstico, Hospital Clínico Universitario San Cecilio.

We present the case of a patient with a history of recurrent acute necrotizing pancreatitis, chronic pancreatitis and a pancreatic pseudocyst with associated pseudoaneurysm in the superior mesenteric artery. He presents active bleeding from the pseudoaneurysm into the lumen of the pseudocyst, reaching the pancreatic duct and through it the intestinal lumen causing hematochezia. This is a case of hemosuccus pancreaticus trated with an interventional approach. Read More

BMC Surg 2020 Dec 1;20(1):307. Epub 2020 Dec 1.

Department of Gastroenterological Surgery and Surgical Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho 2-5-1, Kita-ku, Okayama city, Okayama, 7000914, Japan.

Background: Hemobilia occurs mainly due to iatrogenic factors such as impairment of the right hepatic or cystic artery, and/or common bile duct in hepatobiliary-pancreatic surgery. However, little or no cases with hemobilia from the intra-pancreatic remnant bile duct after bile duct resection (BDR) has been reported. Here, we report a case of massive hemobilia due to the perforation of psuedoaneurysm of the gastroduodenal artery (GDA) to the intra-pancreatic remnant bile duct after hepatectomy with BDR. Read More

Surg Case Rep 2020 Dec 1;6(1):301. Epub 2020 Dec 1.

Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.

Background: The mainstay treatment for arteriovenous malformation in the pancreatic head (Ph-AVM) is standard pancreatectomy, especially pancreaticoduodenectomy (PD), or interventional endovascular treatment. We report the first case of Ph-AVM treated with duodenum-preserving pancreatic head resection (DPPHR) performed to preserve the periampullary organs.

Case Presentation: A 59-year-old man presenting with back pain underwent contrast-enhanced computed tomography followed by angiography of the anterior superior pancreaticoduodenal artery. Read More

Radiographics 2021 Jan-Feb;41(1):58-74. Epub 2020 Nov 27.

From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.).

Traumatic injuries of the pancreas are uncommon and often difficult to diagnose owing to subtle imaging findings, confounding multiorgan injuries, and nonspecific clinical signs. Nonetheless, early diagnosis and treatment are critical, as delays increase morbidity and mortality. Imaging has a vital role in diagnosis and management. Read More

Medicina (Kaunas) 2020 Nov 16;56(11). Epub 2020 Nov 16.

Center for Radiology and Magnetic Resonance Imaging, Clinical Centre of Serbia, Pasterova No. 2, 11000 Belgrade, Serbia.

Pancreatic pseudoaneurysm is a rare but life-threatening clinical entity. In this paper, we present a case of a 74-year-old man, who was admitted to our clinic with a diagnosis of an acute on chronic pancreatitis complicated by walled-off-pancreatic-necrosis, with subsequent development of peripancreatic pseudoaneurysm. After initial conservative management, the patient recovered and was discharged from the hospital. Read More

J Radiol Case Rep 2020 May 31;14(5):7-15. Epub 2020 May 31.

Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore.

Hemosuccus pancreatitis is a rare and potentially fatal cause of upper gastrointestinal bleeding characterized by hemorrhage from the ampulla of Vater via the pancreatic duct. In this case, a patient with chronic pancreatitis on a background of chronic alcoholism is found to have a splenic artery pseudoaneurysm that was bleeding into the pancreatic duct. This was identified on contrast-enhanced computed tomography imaging and successfully managed via microcoil embolization. Read More

J Investig Med High Impact Case Rep 2020 Jan-Dec;8:2324709620965800

Interfaith Medical Center, Brooklyn, NY, USA.

Pancreatic pseudocyst is a common complication of pancreatitis. Pseudocysts may require decompression when they become painful, infected, or start compressing surrounding organs. Decompression is achieved by endoscopic cystogastrostomy. Read More

Endoscopy 2020 Oct 8. Epub 2020 Oct 8.

Azienda Unità Sanitaria Locale della Romagna, Gastroenterology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy.

CVIR Endovasc 2020 Oct 8;3(1):56. Epub 2020 Oct 8.

Assistance Publique - Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, Hôpital Henri-Mondor, Créteil, France.

Background: Post-surgical bleeding of the main portal vein (PV) is a rare event but difficult to manage surgically. Among the different options of treatment, endovascular stenting of the PV can be considered. We reported two cases of stent-graft placement in PV with subsequent closure of the portal vein access with two percutaneous closure devices deployed simultaneously. Read More

Surg Today 2021 Jul 26;51(7):1232-1236. Epub 2020 Sep 26.

Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.

Although arterial pseudoaneurysm is one of the most serious complications after pancreatic surgery, the best practice with maximum efficacy and minimum adverse effects to overcome such a serious situation has not yet been elucidated. We performed endovascular micro-arterial stenting (EMAS) to manage this serious situation while preserving a sufficient hepatic arterial flow, and herein report the technical details and challenges of the procedure. Dilation of the stent using a balloon catheter to adhere to the parent artery, and embolization of the surrounding artery to prevent type I and type II endo-leaks are the most important points for ensuring a successful procedure. Read More