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Ruptured Splenic Artery Pseudoaneurysm Causing Hemorrhage Into a Pancreatic Pseudocyst
Zo C Overton-Hennessy1, A Michael Devane, Steve Fiester
1From the Volusia County Medical Examiner's Office, Daytona Beach, FL.
The American Journal of Forensic Medicine and Pathology
|September 12, 2021
Summary
Fatal exsanguination occurred due to splenic artery hemorrhage into a pancreatic pseudocyst. A cystogastrostomy stent facilitated this rare complication, leading to fatal upper gastrointestinal bleeding.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Pathology
Background:
- A 46-year-old woman with necrotizing pancreatitis developed a giant pseudocyst and splenic artery pseudoaneurysm.
- The patient underwent embolization for a ruptured splenic artery pseudoaneurysm.
Observation:
- The patient presented with hemorrhagic shock weeks after pseudoaneurysm embolization.
- Autopsy revealed a hemorrhagic pancreas with a large pseudocyst containing a cystogastrostomy stent.
Findings:
- Splenic artery hemorrhage into the pancreatic pseudocyst, facilitated by the cystogastrostomy stent, caused fatal upper gastrointestinal bleeding.
- The pseudocyst subsequently ruptured, leading to abdominal hemorrhage. This unique complication pathway is not previously described in literature.
Implications:
- Highlights a rare but fatal complication of chronic pancreatitis and pseudocyst management.
- Emphasizes the potential for cystogastrostomy stents to create unusual hemorrhage pathways.
- Underscores the importance of considering atypical presentations in patients with complex pancreatitis histories.
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