Yücel ÜSTÜNDAĞ, İ. İlker ÖZ, Barış Can ARSLAN, İshak YILDIZHAN1, Bilgin Kadri ARIBAŞ

Akut Nekrotizan Pankreatitin Nadir Bir Komplikasyonu Olan Gastroduodenal Arter Psödoanevrizmasının Tanı ve Embolizasyonu

Psödokist ve walled-off pankreatik nekroz, akut pankreatitin lokal ve sıklıkla cerrahi müdahale gerektiren geç dönem (>4 hafta) komplikasyonlarıdır. Pankreatitin vasküler komplikasyonları morbidite ve mortalitenin önemli bir nedenidir. Arteriyel komplikasyonlar arasında doğrudan arteriyel erozyon veya psödoanevrizma ve visseraliskemi yer alır. Pankreas psödoanevrizması pankreatik veya peripankreatik arterin bir psödokiste erozyonundan kaynaklanan nadir bir vasküler pankreatit komplikasyonudur. Tedavi edilmezse ölümcül komplikasyonlara yol açabilir. Olgumuzda, akut nekrotizan pankreatitin nadir görülen ve kolaylıkla gözden kaçabilen bir komplikasyonu olan gastroduodenal arter psödoanevrizmasının görüntüleme bulgularını ve pankreatitli hastalarda bu tür komplikasyonların tedavisinde endovasküler girişimin önemini sunuyoruz.

Diagnosis and Embolization of Gastroduodenal Artery Pseudoaneurysm as a Rare Complication of Acute Necrotizing Pancreatitis

Pseudocyst and walled-off pancreatic necrosis are local and often late-stage (> 4 weeks) complications of acute pancreatitis. Vascular complications of pancreatitis are an important cause of morbidity and mortality. Arterial complications include direct arterial erosion or pseudoaneurysm and visceral ischemia. Pancreatic pseudoaneurysm is a rare complication of vascular pancreatitis caused by erosion of the pancreatic or peripancreatic artery in a pseudocyst. If left untreated, it can lead to fatal complications. In our case, we present the imaging findings of gastroduodenal artery pseudoaneurysm, a rare and easily overlooked complication of acute necrotizing pancreatitis, and the importance of endovascular intervention in the treatment of such complications in patients with pancreatitis.

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1. Sgantzou IK, Samara AA, Diamantis A, Karagiorgas GP, Zacharoulis D, Rountas C. Pseudoaneurysm of gastroduodenal artery and pulmonary embolism: Rare co-incidence of two complications of pancreatitis. J Surg Case Rep 2020;2020(2):rjz407.
2. Mendelson RM, Anderson J, Marshall M, Ramsay D. Vascular complications of Pancreatitis. ANZ J Surg 2005;75(12):1073-1079.
3. Guralaa D, Polavarapub AD, Idicullac PS, Daoudb M, Gumasteba V. Pancreatic pseudoaneurysm from a gastroduodenal artery. Case Rep Gastroenterol 2019;13(3):450-455.
4. Shawky MS, Tan J, French R. Gastroduodenal artery aneurysm: A case report and concise review of literature. Ann Vasc Dis 2015;8(4):331-333.
5. C. Jain AK, Joshi S, Subramanyam SG, Sinha N. Rupture of gastroduodenal artery pseudoaneurysm. International Journal of Case Reports in Medicine 2013;2013:501114
6. Klauß M, Heye M, Stampfl U, Grenacher L, Radeleff B. Successful arterial embolization of a giant pseudoaneurysm of the gastroduodenal artery secondary to chronic pancreatitis with literature review. J Radiol Case Rep 2012;6(2):9- 16.
7. Bergert H, Hinterseher I, Kersting S, Leonhardt J, Bloomenthal A, Saeger HD. Management and outcome of hemorrhage due to arterial pseudoaneurysms in pancreatitis. Surgery 2005;137(3):323-328.
8. Boudghene F, L’Hermine C, Bigot JM. Arterial complications of pancreatitis: Diagnostic and therapeutic aspects in 104 cases. J VascInterv Radiol 1993;4(4):551-558.
9. Madhusudhan KS, Venkatesh HA, Gamanagatti S, Garg P, Srivastava DN. Interventional radiology in the management of visceral artery pseudoaneurysms: A review of techniques and embolic materials. Korean J Radiol 2016;17(3):351- 363.
10. Zarin M, Ali S, Majid A, Jan Z. Gastroduodenal artery aneurysm-post traumatic pancreatic pseudocyst drainage-an interesting case. Int J Surg Case Rep 2018;42:82-84.
11. Zabicki B, Limphaibool N, Holstad MJV, Juszkat R. Endovascular management of pancreatitis related pseudoaneurysms: A review of techniques. PLoS One 2018;13(1):e0191998.
12. Carr JA, Cho JS, Shepard AD, NypaverTJ, Reddy DJ. Visceral pseudoaneurysms due to pancreatic pseudocysts: Rare but lethal complications of pancreatitis. Vasc Surg 2000;32(4):722-730.