Splenic artery pseudoaneurysm as a complication of pancreatic pseudocyst

Abstract

Introduction. Pancreatic pseudocyst presented as pseudoaneurysm of the splenic artery is a potential serious complication in patients with chronic pancreatitis. Case report. A 42-year-old male patient with a long-standing evolution of chronic pancreatitis and 8-year long evolution of pancreas pseudocyst was referred to the Military Medical Academy, Belgrade due to worsening of the general condition. At admission, the patient was cachectic, febrile, and had the increased values of amylases in urine and sedimentation (SE). After clinical and diagnostic examination: laboratory assessment, esophagogastroduodenoscopy (EGDS), ultrasonography (US), endoscopic ultrasonography (EUS), multislice computed scanner (MSCT) angiography, pseudoaneurysm was found caused by the conversion of pseudocyst on the basis of chronic pancreatitis. The patient was operated on after founding pancreatic pseudocyst, which caused erosion of the splenic artery and their mutual communication. Postoperative course was duly preceded without complications with one year follow-up. Conclusion. Angiography is the most reliable and the safest method for diagnosing hemorrhagic pseudocysts when they clinically present as pseudoaneurysms. A potentially dangerous complication in the presented case was treated surgically with excellent postoperative results.Uvod. Pankreasna pseudocista koja se prezentuje kao psedoaneurizma slezinske arterije je potencijalno opasna komplikacija kod bolesnika sa hronicnim pankreatitisom. Prikaz bolesnika. Bolesnik, star 42 godine, sa dugogodisnjim hronicnim pankreatitisom i osmogodisnjom evolucijom pseudociste pankreasa primljen je u Vojnomedicinsku akademiju, Beograd zbog pogorsanja opsteg stanja. Na prijemu, bolesnik je bio kahektican, febrilan, sa povisenom vrednoscu amilaze u urinu i povisenom sedimentacijom (SE). Nakon klinicke i dijagnosticke evaluacije: laboratorijski nalazi, ezofagogastroduodenoskopija (EGDS), ultrazvucni pregled (US) abdomena, endoskopski ulztrazvucni (EUS) pregled, multislajsna skenerska (MSCT) angiografija, nadjena je pseudoaneurizma koja je nastala konverzijom pseudociste na bazi hronicnog pankreatitisa. Bolesnik je operisan kada je nadjena pseudocista pankreasa koja je dovela do erozije slezinske arterije i njihove medjusobne komunikacije. Postoperativni tok prosao je uredno, sa pracenjem bolesnika u narednih godinu dana bez komplikacija. Zakljucak. Angiografija je najpouzdanija i najsigurnija metoda za dijagnostikovanje hemoragicne pseudociste, koja se klinicki prezentuje kao pseudoaneurizma. Kod prikazanog bolesnika potencijalno opasna komplikacija lecena je hirurski sa odlicnim postoperativnim rezultatom.