Pseudoaneurysmata viscerálních tepen jako komplikace akutní pankreatitidy: zkušenosti terciárního centra

Autori: Alena Ondrejkova M.D.¹,², Michael A. McKusick M.D.³, Santhi Swaroop Vege M.D.²

Pracovisko: Dpt. of Internal Medicine, St. Anne’s University Hospital Brno, International Clinical Research Center, Brno, Czech Republic¹  Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA²  Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA³

Abstrakt: 

Introduction: Arterial pseudoaneurysm is a rare vascular complication of acute pancreatitis (AP). We aimed to assess the frequency, clinical course, treatment patterns and outcome of splanchnic artery pseudoaneurysms in a well-defined cohort of AP patients.

 

Methods: In the study, records of 3257 consecutive patients of AP from January 2001 to June 2014 were retrospectively analysed for the occurence of pseudoaneurysm. Demographic characteristics, clinical presentation, diagnostic studies, treatment and outcome were analyzed in 22 patients.

Results: The mean age was 59 years (range 26-86 years), 86% were males. 95% of patients had necrotising type of pancreatitis with associated acute or mature collection. The most common etiology of underlying AP was biliary (50%). A total of 24 pseudoaneurysms were determined (2 patients having 2 pseudoaneurysms), 67% of all pseudoaneurysms arised from splenic or gastroduodenal artery. The maximum diameter varies from 0.4 to 7cm. The median time from AP episode to pseudoaneurysm diagnosis was 38 days (range 1-178 days). 2 patients with stable pseudoaneurysms remained asymptomatic, the leading manifestation of rupture was abdominal pain (77%), followed by gastrointestinal (GI) bleeding (50%). CT demonstrated pseudoaneurysm or hemorrhage in 89% of cases. All patients with GI bleeding underwent esophagogastroduodenoscopy, in 36% no bleeding source was found. 91% patients underwent interventional radiology treatment with 100% success rate, 20% of them needed repeated intervention. Spontaneous resolution without definitive treatment was observed in 9%. No patients required operative treatment. The most common complication was splenic infarction (15%). There was no in-hospital or 30 day mortality in the cohort.

 

Discussion: Arterial pseudoaneurysm is an uncommon complication of AP with estimated frequency of 0.7%. Interventional radiology is effective and safe treatment modality. There is chance of spontaneous regression of tiny pseudoaneurysms. Although high mortality has been reported historically, early diagnosis, advanced imaging techniques and minimally invasive treatment options can improve prognosis of the patients.