From Pseudocyst to Pseudoaneurysm: A Complex Pancreatic Vascular Emergency Managed With a Multi-stage Interventional...

Area of Science:

• Interventional Radiology
• Vascular Surgery
• Gastroenterology

Background:

• Acute-on-chronic pancreatitis frequently leads to pancreatic pseudocysts (PPs).
• Hemorrhage into PPs, often from pseudoaneurysms (PAs) of adjacent arteries, is a critical complication.
• Surgical options for hemorrhagic PPs with PAs are often high-risk or unfeasible.

Observation:

• A 43-year-old male with chronic pancreatitis and liver cirrhosis presented with melaena.
• CT imaging revealed a hemorrhagic pancreatic pseudocyst in the pancreatic head with active bleeding from multiple arterial feeders.
• The patient had a history of alcohol-related liver disease and recurrent chronic pancreatitis.

Findings:

• Successful management of a hemorrhagic pancreatic pseudocyst with pseudoaneurysms using multiple interventional radiology (IR) embolization sessions.
• A combination of coils, Glubran II glue, and stent placement was required to occlude all feeding vessels.
• This represents the first reported case of a persistently hemorrhagic PP managed with a multi-stage IR approach, including novel techniques.

Implications:

• Endovascular embolization is the primary treatment for pseudoaneurysms in hemorrhagic pancreatic pseudocysts.
• Interventional radiology offers a life-saving alternative when surgical interventions are not viable.
• This case underscores the importance of multidisciplinary decision-making and advanced embolization techniques for complex vascular complications.