Gamanagatti S, Thingujam U, Garg P, Nongthombam S, Dash NR. Endoscopic ultrasound guided thrombin injection of angiographically occult pancreatitis associated visceral artery pseudoaneurysms: Case series. World J Gastrointest Endosc 2015; 7(13): 1107-1113 [PMID: 26421108 DOI: 10.4253/wjge.v7.i13.1107]
Corresponding Author of This Article
Dr. Shivanand Gamanagatti, MD, Additional Professor, Department of Radiodiagnosis, All India Institute of Medical Sciences, Room no 81-B, Ansari Nagar, New Delhi 110029, India. shiv223@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Shivanand Gamanagatti, Usha Thingujam, Department of Radiodiagnosis, India Institute of Radiodiagnosis, Ansari Nagar, New Delhi 110029, India
Pramod Garg, Surajkumar Nongthombam, Department of Gastroenterology, India Institute of Radiodiagnosis, Ansari Nagar, New Delhi 110029, India
Nihar Ranjan Dash, Department of Gastrointestinal Surgery and Transplantation, India Institute of Radiodiagnosis, Ansari Nagar, New Delhi 110029, India
Author contributions: Gamanagatti S contributed equally to conception, article design, and image preparation; Thinujam U helped with the literature search and article drafting; Garg P helped to procure the images, and final approval of version of article to be published; Nongthombam S and Dash NR, contributed in critical revision article concept, revision literature search and image preparation.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the by the All India Institute of Medical Sciences (New Delhi, India).
Informed consent statement: Informed consent for performing the procedure was taken from all patients after explaining the risks and benefits. Regarding consent for the publication was not obtained and also these patients are no longer in communication with us (lost to follow up), hence we here by certify that, all the patient demographic information on images (figures) is hidden (cropped) to maintain confidentiality.
Conflict-of-interest statement: The authors have nothing to disclose.
Correspondence to: Dr. Shivanand Gamanagatti, MD, Additional Professor, Department of Radiodiagnosis, All India Institute of Medical Sciences, Room no 81-B, Ansari Nagar, New Delhi 110029, India. shiv223@gmail.com
Telephone: +91-11-26594567 Fax: +91-11-26588500
Received: March 29, 2015 Peer-review started: March 29, 2015 First decision: May 13, 2015 Revised: May 24, 2015 Accepted: August 30, 2015 Article in press: August 31, 2015 Published online: September 25, 2015 Processing time: 179 Days and 16.7 Hours
Abstract
Pseudoaneurysm is a known complication of pancreatitis associated with significant mortality and morbidity. Imaging plays an important role in the diagnosis and management. Computed tomography (CT) helps localize the lesion and the severity of the background pancreatitis but digital subtraction angiography with coil embolization is recommended to avoid bleeding and inadvertent surgery. However, in cases where angiographic coil embolization is not feasible due to technical reasons, thrombin injection via CT or ultrasound guidance remains a viable option and often described in literature. In this series, effort has been made to highlight the role of endoscopic ultrasound guided thrombin instillation especially in patients with poorly visualized pseudoaneurysm on ultrasound thereby avoiding surgery and the associated mortality and morbidity.
Core tip: In cases where angiographic coil embolization is not feasible due to technical reasons, thrombin injection via computed tomography or ultrasound guidance remains a viable option. Endoscopic ultrasound guided thrombin injection is a new development in this realm especially in those patients where the visualization of the pseudoaneurysm is difficult on transabdominal ultrasound thereby avoiding the need of surgery and the associated morbidity.
