• PPP syndrome
• pancreatitis
• panniculitis
• polyarthritis

• angioembolization
• bleeding
• hemorrhage
• pancreatitis
• surgery

• Humans
• Pancreatitis/complications
• Gastrointestinal Hemorrhage/etiology
• Hemorrhage/etiology
• Tomography, X-Ray Computed/methods
• Aneurysm, False

• Case report
• Digital subtraction angiography
• Intra-abdominal hemorrhage
• Pseudoaneurysm
• Severe acute pancreatitis

• Active bleeding
• Computed tomography
• Emergency
• Hemorrhage
• Trauma

• Humans
• Hemorrhage/diagnostic imaging
• Hemorrhage/therapy
• Embolization, Therapeutic/methods
• Emergency Service, Hospital
• Tomography, X-Ray Computed
• Contrast Media
• Radiologists
• Extravasation of Diagnostic and Therapeutic Materials/diagnostic imaging
• Extravasation of Diagnostic and Therapeutic Materials/therapy
• Radiology, Interventional
• Radiography, Interventional

• Glycocalyx/metabolism
• Erythrocyte Aggregation
• Humans
• Erythrocytes/metabolism

• chronic pancreatitis
• pancreatic pseudocyst
• pseudoaneurysm
• walled-off necrosis

• Humans
• Aneurysm, False/therapy
• Aneurysm, False/etiology
• Pancreatitis, Chronic/complications
• Pancreatitis, Chronic/therapy
• Male
• Early Diagnosis
• Embolization, Therapeutic/methods
• Middle Aged
• Treatment Outcome
• Minimally Invasive Surgical Procedures/methods

Pancreatic pseudoaneurysm is a rare vascular complication of chronic pancreatitis (CP) or necrotizing pancreatitis with an incidence of 4% to 17%, but it is potentially life-threatening. It is well known that most pancreatic pseudoaneurysms are clinically associated with pancreatic pseudocysts and are usually in the peripancreatic body-tail. A minority of intrapancreatic pseudoaneurysms occur in the absence of pseudocyst formation. Noninvasive computed tomography (CT) and magnetic resonance imaging (MRI) are most commonly used examinations for screening pancreatic pseudoaneurysms. Notably, the rare intrapancreatic pseudoaneurysm in the pancreatic head can mimic a hypervascular solid mass and be misdiagnosed as a pancreatic tumor.

We report the case of a 67-year-old man who had been admitted to our hospital due to recurrent abdominal pain for 1 mo that was aggravated for 5 d. CT and MRI revealed a mass in the pancreatic head with significant expansion of the main pancreatic duct and mild atrophy of the pancreatic body-tail. He was admitted to the department of hepatobiliary and pancreatic surgery due to the possibility of a pancreatic tumor. The patient was then referred for endoscopic ultrasonography (EUS) with possible EUS-FNA. However, EUS showed a cystic lesion in the pancreatic head with wall thickness and enhancing nodules, which was doubtful because it was inconsistent with the imaging findings. Subsequently, color doppler flow imaging demonstrated turbulent arterial blood flow in the cystic lesion and connection with the surrounding vessel. Therefore, we highly suspected the possibility of CP complicated with intrapancreatic pseudoaneurysm, combined with the patient's long-term drinking history and the sonographic features of CP. Indeed, angiography revealed an oval area of contrast medium extravasation (size: 1.0 cm × 1.5 cm) at the far-end branch of the superior pancreaticoduodenal artery, and angiographic embolization was given immediately at the same time.

EUS is an important differential diagnostic tool when pancreatic pseudoaneurysm mimics the imaging appearance of a hypervascular pancreatic tumor.

• Pancreatic pseudoaneurysm
• Chronic pancreatitis
• Pancreaticoduodenal artery
• Endoscopic ultrasonography
• Case report

• Chronic pancreatitis
• Pseudoaneurysm
• Varices
• Vascular complications
• Venous thrombosis

• chronic pancreatitis
• hepatic artery pseudoaneurysm
• transarterial embolization

• Male
• Humans
• Adult
• Aneurysm, False/etiology
• Hepatic Artery
• Pancreatitis, Chronic/complications
• Pancreas/blood supply
• Gastrointestinal Hemorrhage/etiology

Background  Acute pancreatitis is a significant challenge to health services. Remarkable progress has been made in the last decade in optimizing its management.

Methods  This review is a comprehensive assessment of 7 guidelines employed in current clinical practice with an appraisal of the underlying evidence, including 15 meta-analyses/systematic reviews, 16 randomized controlled trials, and 31 cohort studies.

Results  Key tenets of early management of acute pancreatitis include severity stratification based on the degree of organ failure and early goal-directed fluid resuscitation. Rigorous determination of etiology reduces the risk of recurrence. Early enteral nutrition and consideration of epidural analgesia have been pioneered in recent years with promising results. Indications for invasive intervention are becoming increasingly refined. The definitive indications for endoscopic retrograde cholangiopancreatography in acute pancreatitis are associated with cholangitis and common bile duct obstruction. The role of open surgical necrosectomy has diminished with the development of a minimally invasive step-up necrosectomy protocol. Increasing use of endoscopic ultrasound–guided intervention in the management of pancreatic necrosis has helped reduce pancreatic fistula rates and hospital stay.

Conclusion  The optimal approach to surgical management of complicated pancreatitis depends on patient physiology and disease anatomy, in addition to the available resources and expertise. This is best achieved with a multidisciplinary approach. This review provides a distillation of the recommendations of clinical guidelines and critical discussion of the evidence that informs them and presents an algorithmic approach to key areas of patient management.

• acute pancreatitis
• necrotizing pancreatitis
• pseudocyst
• biliary pancreatitis

• Chronic pancreatitis
• Classification
• Complications
• Pathophysiology
• Surgical treatment

• Chronic pancreatitis
• Embolization
• Outcome
• Pseudoaneurysm
• Surgery

• Adult
• Aneurysm, False/etiology
• Aneurysm, False/surgery
• Embolization, Therapeutic/adverse effects
• Female
• Hemorrhage
• Humans
• Male
• Middle Aged
• Pancreatectomy
• Pancreatitis, Chronic/complications
• Pancreatitis, Chronic/surgery
• Retrospective Studies

• Acute respiratory distress syndrome
• Critical care
• Guidelines
• Intensive care unit
• Sepsis
• Severe acute pancreatitis

• Acute Disease
• Critical Care
• Humans
• Pancreatitis/therapy

• Children
• Hemobilia
• Hepatic artery
• Pseudoaneurysm
• Radiological embolization

• Adult
• Aneurysm, False/diagnosis
• Aneurysm, False/diagnostic imaging
• Angiography
• Child
• Embolization, Therapeutic
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Hepatic Artery
• Humans
• Male

• Brain abscess
• Case report
• Epistaxis
• Granulation
• ICA pseudoaneurysm

Introduction. 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. Most often, abdominal pain is the presenting complaint, but this can be complicated as classic symptoms of pancreatitis also present with abdominal pain. Herein, we present a patient with an acute on chronic gastrointestinal bleed that was finally attributed to a pancreatic pseudoaneurysm. Case Presentation. The patient was a 56-year-old male with a past medical history significant for epilepsy, alcohol abuse, and hypertension who presented as a transfer from an outside facility for a gastrointestinal bleed. Prior to presentation, the patient reported rectal bleeding over the prior 1.5 months but had not sought care until bleeding increased along with increased abdominal pain. The patient's hemoglobin was 6.3 at presentation of the outside facility and received a total of four units of packed red blood cells (PRBCs) prior to arrival. After arrival, persistent bleeding was noted, and an additional 2 units of PRBCs were transfused. A computed tomography angiography (CTA) of the abdomen was obtained to identify the source for embolization. This, however, revealed a 4 × 4 × 3.5 cm intrinsically dense or enhanced mass of the pancreatic head. Discussion. Pancreatic pseudoaneurysm is a rare but potentially fatal complication that can follow pancreatitis. In chronic pancreatitis patients who underwent imaging incidence is estimated to be up to 10%. Treatment is difficult, and coil embolization is often used, though this can lead to splenectomy due to splenic ischemia. Stent grafts can be used in the surrounding arteries to maintain the integrity of viscera but carry risk of stent-related thrombosis. Further research is needed on the optimal management of this potentially lethal complication of pancreatitis.

• celiac artery pseudoaneurysm
• chronic pancreatitis
• pancreatic pseudoaneurysms
• pancreatitis

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. However, he soon returned feeling anxious due to a pulsatile abdominal mass. Abdominal Color–Doppler examination, CT scan, and angiography revealed large pancreatic necrotic collection in the total size of 9 cm, with centrally enhancing area of 3.5 cm that corresponded to pseudoaneurysm originating from the posterior pancreaticoduodenal vascular arcade. Considering the size, location of the pseudoaneurysm, feeding vessel, and poor general patients condition, we opted for minimally invasive treatment. Pseudoaneurysm was successfully managed by endovascular coil embolization, i.e., “sandwich technique”.

• angiography
• chronic pancreatitis
• minimally invasive treatment
• pancreas
• pancreatic pseudoaneurysm
• sandwich technique

• Aged
• Aneurysm, False/complications
• Aneurysm, False/diagnostic imaging
• Aneurysm, False/therapy
• Arteries
• Embolization, Therapeutic
• Humans
• Male
• Pancreas/diagnostic imaging
• Pancreatitis, Chronic/complications
• Pancreatitis, Chronic/therapy

•

A 50-year-old patient presented with multiple idiopathic arterial deteriorations.

Peripheral artery pseudoaneurysm as a consequence of arterial deterioration is relatively rare in young populations, who typically lack an atherosclerotic background. Such pseudoaneurysms are known to pose a risk of rupture, which is correlated with high mortality and morbidity rates. Pseudoaneurysms are more prone to rupture than true aneurysms are, as their vessel walls tear more easily. We present the case of a 50-year-old patient who had multiple arterial deteriorations.

The patient experienced backache, and computed tomography revealed a tear of the right renal artery, and a pseudoaneurysm of the left internal iliac artery. He had a history of graft replacement for the right superficial artery pseudoaneurysm, which had been occluded. Although various tests were performed for differential diagnosis, the etiology was unidentified. Considering the suspected vascular fragility and failure of previous direct intervention, these 2 lesions were treated by placing endografts simultaneously.

We investigated various diseases causing vascular fragility in the reported case, such as vascular Behçet disease, vascular Ehlers-Danlos syndrome, fibromuscular dysplasia, and segmental arterial mediolysis. However, these were all excluded and the etiology remains unclear. Progress in endovascular techniques enables the use of minimally invasive treatment in patients with vascular fragility.

When vascular fragility may exist, endovascular treatment is a desirable option, as it can be performed repetitively and is less invasive.

• Artery rupture
• Endovascular therapy
• Pseudoaneurysm

Transcatheter arterial embolization (TAE) with coils is widely used to treat pseudoaneurysms; recently, the use of N-butyl cyanoacrylate (NBCA) in TAE has been reported as a feasible and effective approach. The purpose of our retrospective study was to evaluate the efficacy and safety of TAE with coils and NBCA for pseudoaneurysms associated with pancreatitis or pancreatic surgery. This retrospective study included 42 consecutive patients. The technical and clinical success rates, incidence of recurrent bleeding, complications, including pancreatitis, and overall survival after TAE were evaluated. All cases obtained hemostasis after TAE (the technical success rate was 100%). Complications were seen in only two patients. Clinical success rate that was evaluated in terms of 30-day mortality was 76.2%. TAE is then an effective treatment modality for pseudoaneurysms associated with pancreatitis or pancreatic surgery. Accurate diagnosis using angiography contributes to the proper choice of embolic agents and management of such hemorrhages.

Purpose: To evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for pseudoaneurysms occurring secondary to pancreatitis or because of leakage of pancreatic juice after pancreatectomy. Materials and Methods: This retrospective study included 42 consecutive patients (38 males and 4 females; mean age, 60 years; range, 33–80 years) who underwent TAE for bleeding visceral artery pseudoaneurysms between March 2004 and December 2018. The technical and clinical success rates, incidence of recurrent bleeding, complications, including pancreatitis, and overall survival after TAE were evaluated. Results: Of the 42 enrolled patients, 23 had bleeding due to a complication of pancreatectomy and 19 had bleeding as a complication of pancreatitis. TAE with N-butyl cyanoacrylate (NBCA) or NBCA plus microcoils recurrent bleeding or inability to control bleeding was 15.8% (3 of 19) following TAE with NBCA and 17.4% (4 of 23) following TAE with coils. No clinically significant ischemic events of the pancreas or duodenum were observed in the embolized areas. Serum amylase did not increase compared with the initial levels after any of the procedures. At 30 days after TAE, 32 patients were alive. Conclusion: TAE has a high success rate for the management of hemorrhage, with few complications. The procedure appears to be safe and effective for pseudoaneurysms associated with either pancreatitis or pancreatectomy.

• NBCA
• embolization
• pancreatic fistula
• pancreatitis
• postoperative hemorrhage

The course of severe acute pancreatitis (SAP) complicated by hemorrhage is associated with poor outcome.

Twenty-four (13%) out of 183 cases of SAP had hemorrhagic complications- 12 intraabdominal & 12 intraluminal, 13 had major & 11 had minor and 16 had de-novo & 8 post-surgical bleeding. The mean duration of pancreatitis prior to bleeding was 27±27.2 days.

Predictors of haemorrhage on univariate analysis were delayed admission (0.037), more than one organ failure (p=0.008), presence of venous thrombosis (p=0.033), infective necrosis (0.001) and systemic sepsis – bacterial (0.037) & fungal (p=0.032). On multivariate analysis infected necrosis (OR=11.82) and presence of fungal sepsis (OR=3.73) were the significant factors. Patients presenting with more than one organ failure and bacterial sepsis had borderline significance on multivariate analysis. Need for surgery (50% vs. 12.6%), intensive care stay (7.4±7.9 vs. 5.4±5.2 days) and mortality (41.7% vs. 10.7%) were significantly higher in patients who suffered haemorrhage. Seven of the 13 with major bleeding had pseudoaneurysms-4 were embolized, 4 needed surgery including 1 embolization failure. Seven with intraabdominal bleeding required surgical intervention, 2 had successful embolization and 3 had expectant management. CT severity index and surgical intervention, were significantly associated with intraabdominal bleeding. Organ failure, presence of pseudoaneurysm and surgical intervention were associated with major bleeding.

Hemorrhage in SAP was associated with increased morbidity and mortality. Infected necrosis accentuated the degradation of the vessel wall, which predispose to hemorrhage. Luminal bleeding may be indicative of erosion into the adjacent viscera by the pseudoaneurysm.

• Abdominal
• Acute
• Bleeding
• Complication
• Haemorrhage
• Pancreatitis
• Pseudoaneurysm

Preventing and curing complications of acute and chronic pancreatitis, which may be local or systemic, remains a challenge. Pseudocysts and walled-off pancreatic necrosis are two local complications that most frequently require surgical intervention. Two rare complications of pancreatitis are pseudoaneurysms and pulmonary embolism. Angiographic embolization can be the treatment of choice for pseudoaneurysms, while for pulmonary embolism apart from anticoagulation treatment, the optional inferior vena cava filter placement could be useful. As far as we know, in literature, these complications of pancreatitis have never been reported simultaneously yet.

• angiographic embolization
• complications
• pancreatitis
• pseudoaneurysm
• pseudoaneurysm of gastroduodenal artery
• pulmonary embolism

• Acute Disease
• Conservative Treatment/methods
• Disease Management
• Drainage/methods
• Endoscopy/methods
• Humans
• Pancreatitis/diagnosis
• Pancreatitis/therapy
• Progressive Patient Care/methods

• Acute abdomen imaging
• Binge drinking
• Boerhaave's syndrome
• Gastrointestinal haemorrhage
• Pancreatitis
• Spontaneous bladder rupture

• Abdominal Pain/diagnostic imaging
• Abdominal Pain/etiology
• Binge Drinking/complications
• Diagnostic Imaging/methods
• Digestive System/diagnostic imaging
• Digestive System Diseases/diagnostic imaging
• Digestive System Diseases/etiology
• Emergencies
• Esophageal Diseases/diagnostic imaging
• Esophageal Diseases/etiology
• Gastrointestinal Diseases/diagnostic imaging
• Gastrointestinal Diseases/etiology
• Gastrointestinal Tract/diagnostic imaging
• Humans
• Urinary Tract/diagnostic imaging
• Urologic Diseases/diagnostic imaging
• Urologic Diseases/etiology

• CTA
• DSA
• Embolization
• Pancreatic pseudocyst
• Visceral pseudoaneurysm

• Adult
• Alcoholism/complications
• Aneurysm, False/diagnostic imaging
• Aneurysm, False/etiology
• Aneurysm, False/surgery
• Angiography/methods
• Arteries/diagnostic imaging
• Arteries/surgery
• Chronic Disease
• Computed Tomography Angiography
• Contrast Media
• Diagnosis, Differential
• Embolization, Therapeutic
• Endovascular Procedures
• Female
• Hemorrhage/diagnostic imaging
• Hemorrhage/etiology
• Hemorrhage/surgery
• Humans
• Pancreas/blood supply
• Pancreas/diagnostic imaging
• Pancreas/surgery
• Pancreatitis/complications
• Pancreatitis/diagnostic imaging
• Treatment Outcome
• Ultrasonography

• arterial pseudoaneurysms
• chronic pancreatitis
• endovascular embolisation

• cystic mucinous pancreasic tumor
• wirsungorrhagia

• Chronic
• Embolization
• Hemosuccus
• Pancreatitis
• Pseudoaneurysm
• Thrombin

• endovascular procedures
• pancreatic surgery

To present the various techniques used in the management of pancreatitis-related pseudoaneurysms of visceral vessels.

The retrospective clinical study was carried out at the Department of Diagnostic and Interventional Radiology at Poznan University of Medical Sciences from 2011 to 2016. The fifteen patients included in the study were diagnosed with pseudoaneurysms of visceral arteries, as a complication of chronic pancreatitis. The diagnosis was made using contrast-enhanced computed tomography, followed by angiography. On admission, all patients were symptomatic, with varying degrees of abdominal pain. One patient was haemodynamically unstable. Treatments with endovascular techniques were analysed, along with their efficacy and outcomes. Coil embolisation was performed in 5 patients. Stent graft was used in 1 patient. Liquid embolic agents were used in 7 cases, of which 5 patients were treated with thrombin injection and 2 with Squid. A combination of techniques was used in 2 patients.

The most common artery affected by pseudoaneurysm formation was the splenic artery (7/15; 46.7%), and the size of the pseudoaneurysms ranged from 27 mm to 85 mm. Primary technical success was achieved in 14 out of 15 patients (93.3%). One patient required reintervention. Two patients required splenectomy after embolisation due to splenic ischemia. No recanalisation was present at the follow-up computed tomography performed after 1 to 3 weeks, and no mortality was observed within 30 days.

Vascular complications of pancreatitis require accurate diagnosis and immediate treatment. Endovascular intervention is highly effective and is the preferred treatment option. The technique used is determined based on vascular anatomy and the patient’s haemodynamic status.

• Aneurysm, False/complications
• Aneurysm, False/diagnostic imaging
• Aneurysm, False/surgery
• Contrast Media
• Humans
• Pancreatitis/complications
• Retrospective Studies
• Tomography, X-Ray Computed

• Acute pancreatitis
• Angioembolisation
• Gall stones
• Portal hypertension
• Pseudoaneurysm
• Self-expanding metallic stents
• Transmural drainage
• Walled off pancreatic necrosis

Pancreatitis represents nearly 3% of acute admissions to general surgery in United Kingdom hospitals and has a mortality of around 1%-7% which increases to around 10%-18% in patients with severe pancreatitis. Patients at greatest risk were those identified to have infected pancreatic necrosis and/or organ failure. This review seeks to highlight the potential vascular complications associated with pancreatitis that despite being relatively uncommon are associated with mortality in the region of 34%-52%. We examine the current evidence base to determine the most appropriate method by which to image and treat pseudo-aneurysms that arise as the result of acute and chronic inflammation of pancreas. We identify how early recognition of the presence of a pseudo-aneurysm can facilitate expedited care in an expert centre of a complex pathology that may require angiographic, percutaneous, endoscopic or surgical intervention to prevent catastrophic haemorrhage.

• Complication of pancreatitis
• Splenicartery
• Pancreatitis
• Haemorrhage
• Pseudoaneurysm

• Aneurysm, False/diagnostic imaging
• Aneurysm, False/etiology
• Aneurysm, False/therapy
• Angiography/methods
• Contrast Media/administration & dosage
• Embolization, Therapeutic/methods
• Endoscopy, Gastrointestinal
• Hemorrhage/diagnostic imaging
• Hemorrhage/etiology
• Hemorrhage/therapy
• Hospitalization/statistics & numerical data
• Humans
• Incidence
• Magnetic Resonance Imaging
• Necrosis
• Pancreas/blood supply
• Pancreas/pathology
• Pancreatectomy/adverse effects
• Pancreatectomy/methods
• Pancreatitis, Acute Necrotizing/complications
• Pancreatitis, Acute Necrotizing/epidemiology
• Pancreatitis, Acute Necrotizing/pathology
• Pancreatitis, Chronic/complications
• Pancreatitis, Chronic/diagnostic imaging
• Pancreatitis, Chronic/epidemiology
• Pancreatitis, Chronic/pathology
• Time Factors
• Tomography, X-Ray Computed/methods
• United Kingdom/epidemiology

• Acute pancreatitis
• Chronic pancreatitis
• Computed tomography (CT)
• Pseudocyst
• Residual fluid collections
• Residual peripancreatic inflammation

Abdominal bleeding is a lethal complication in acute pancreatitis (AP) and it is commonly described as a late event. However, spontaneous intra-abdominal bleeding could occur very early but no study focusing on this phenomenon was published yet. In this study, 1137 AP patients were retrospectively screened and 24 subjects suffering early spontaneous bleeding (ESB) were selected. Meanwhile, a 1:1 well-balanced cohort of non-bleeding patients was generated by propensity score match. The clinical characteristics of these patients were compared and a multiple regression analysis was performed to assess the risk factors for ESB. Besides, patients with massive post-intervention bleeding (PIB) were collected for additional comparison. ESB patients suffered significantly worse outcome than the matched cohort evidenced by dramatically higher mortality than the non-bleeding patients and even the PIB group (54.2% versus 20.8%, P = 0.017; 54.2% versus 31.0%, P = 0.049). The regression analysis demonstrated computer tomography severity index (CTSI; OR, 3.34; 95% CI, 1.995–5.59, P < 0.001) and creatinine (OR, 1.008; 95% CI, 1.004–1.012, P < 0.001) were associated with the occurrence of ESB. In conclusion, ESB is a rare but dangerous complication of moderate-to-severe AP and may result in high mortality. CTSI and creatinine are independent risk factors for the development of ESB.

• APACHE
• Acute pancreatitis
• Pancreatic haemorrhage
• Pancreatic necrosis
• Systemic inflammatory response
• Xigris

• Endoscopic retrograde cholangiopancreatography
• Extracorporeal shock wave lithotripsy
• Metal stents
• Multiple plastic stent
• Painful chronic pancreatitis
• Pancreatic calculi
• Pseudocyst
• Stricture

• Calculi/complications
• Calculi/surgery
• Cholangiopancreatography, Endoscopic Retrograde/instrumentation
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Cholangiopancreatography, Magnetic Resonance
• Constriction, Pathologic/complications
• Constriction, Pathologic/surgery
• Endosonography
• Humans
• Lithotripsy
• Pancreatic Ducts/pathology
• Pancreatic Ducts/surgery
• Pancreatic Pseudocyst/complications
• Pancreatic Pseudocyst/diagnostic imaging
• Pancreatic Pseudocyst/surgery
• Pancreatitis, Chronic/etiology
• Pancreatitis, Chronic/surgery
• Self Expandable Metallic Stents