1/98. Post-traumatic pancreatitis with associated aneurysm of the splenic artery: report of 2 cases and review of the literature.In patients with acute pancreatitis, profuse gastrointestinal bleeding is associated with a high death rate. The cause of such bleeding must be evaluated and the bleeding controlled urgently. Aneurysm formation is usually the cause of the bleeding. angiography is needed to make a definitive diagnosis and the bleeding site should be controlled by angiographic embolization if possible. If this fails, aneurysm resection is necessary. Two patients are described. Both had aneurysms of the splenic artery, presenting as massive gastrointestinal bleeding in one patient and bleeding into an associated pseudocyst in the other. They required surgical repair, which was successful in both cases.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
2/98. Spontaneous thrombosis of a pseudoaneurysm complicating pancreatitis.patients with a visceral aneurysm are at high risk for acute transpapillary, intra-, or retroperitoneal hemorrhage, necessitating either surgical or endovascular therapy. We report an instance of spontaneous thrombosis of a pseudoaneurysm complicating pancreatitis before endovascular treatment could be performed. causality and the literature of spontaneous thrombosis in pseudoaneurysms are discussed.- - - - - - - - - - ranking = 48.577229946029keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
3/98. Management of severe acute pancreatitis with a somatostatin analog in a patient undergoing surgery for dissecting thoracic aneurysm: report of a case.A patient who was admitted to our hospital to undergo surgery for a dissecting thoracic aneurysm suffered preoperatively from severe acute pancreatitis with pancreatic pseudocysts. Computerized tomography (CT) demonstrated the presence of new fluid collection around the cyst with the absence of pancreatic necrosis. He was given a somatostatin analog (sandostatin), which was effective in decreasing the abdominal symptoms, leukocyte counts, and the serum C-reactive/protein level. A CT scan revealed that the pancreatic pseudocyst and peripancreatic fluid collection had disappeared. Although somatostatin has been reported to be ineffective for acute pancreatitis with necrosis, pancreatitis without necrosis may regress after treatment with sandostatin. This is probably due to its suppressive effect on the exocrine function, thus resulting in a decrease of pancreatic juice infiltration.- - - - - - - - - - ranking = 0.83333333333333keywords = aneurysm (Clic here for more details about this article) |
4/98. Abdominal aortic aneurysm compression is probably responsible for the recurrent episodes of acute pancreatitis: case report.An aged male with a known history of abdominal aortic aneurysm suffered from epigastralgia, vomiting and cold sweating for one day. According to the physical examination, serum amylase level and computed tomographic examination, acute pancreatitis was diagnosed. Surgical intervention for the abdominal aortic aneurysm was not performed because of his age, and finally this patient died after three recurrent episodes. Acute pancreatitis co-existing with an intact abdominal aortic aneurysm has never been reported before. The possible pathogenesis of this recurrent acute pancreatitis was discussed.- - - - - - - - - - ranking = 1.1666666666667keywords = aneurysm (Clic here for more details about this article) |
5/98. Massive intraperitoneal bleeding from tryptic erosions of the splenic vein. Another cause of sudden deterioration during recovery from acute pancreatitis.Acute bleeding is a rare, but frequently fatal complication of pancreatitis. Bleeding into the gastrointestinal tract may occur owing to gastric or duodenal erosions, peptic ulcers, or varices in the esophagus, stomach, or colon following splenic vein thrombosis, or intraperitoneally from eroded vessels in pancreatic pseudocysts or expanding pseudoaneurysms. We report a novel case of massive intraperitoneal bleeding owing to tryptic erosions of the splenic vein in a patient recovering from acute pancreatitis. diagnosis of the bleeding was made by ultrasound and ultrasound-guided blood aspiration. The source of the bleeding was identified intraoperatively, and a left-sided pancreatectomy and a splenectomy were performed.- - - - - - - - - - ranking = 8.0684272132271keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
6/98. Transcatheter embolization of a superior mesenteric artery pseudoaneurysm. A case report.A 61-year-old man, with pseudoaneurysm of the superior mesenteric artery presenting with gastrointestinal bleeding, was successfully treated by transcatheter embolization using interlocking detachable coils. During the following observation time of 10 months, the patient had no sign of gastrointestinal bleeding. We underline the importance and feasibility of transcatheter embolization as the first-line treatment in such pseudoaneurysms.- - - - - - - - - - ranking = 48.410563279362keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
7/98. Acute pancreatitis following resection of juxtarenal abdominal aortic aneurysm.A case of acute pancreatitis following resection of a juxtarenal abdominal aortic aneurysm is reported. The patient was a 73 year old man who underwent resection of a juxtarenal abdominal aortic aneurysm. The aneurysm was repaired with a 20 mm. gelatin coated Dacron graft. Proximal control of the aneurysm was performed with supraceliac aortic cross clamping. The clamping time was 50 minutes. Postoperatively, he developed progressive abdominal distension with deterioration of renal and pulmonary function necessitating relaparotomy on the 7th postoperative day. The second operation revealed evidence of saponification and fat necrosis in the omentum. The pancreas was edematous and swollen compatible with acute pancreatitis. The aortic graft and other intraabdominal organs appeared normal. Despite intensive supportive care, the patient died 2 weeks later from multiple system organ failure. The possible causes of acute pancreatitis following aortic surgery described in the literature are 1. systemic and regional hypoperfusion, 2. atheromatous emboli to arteries supplying the pancreas and 3. direct trauma to the pancreas during the operation from retractors or surgical dissection. All of which may be the etiology of acute pancreatitis in our patient. Avoidance of such factors during aortic surgery is recommended to prevent this potentially fatal complication.- - - - - - - - - - ranking = 1.3333333333333keywords = aneurysm (Clic here for more details about this article) |
8/98. Aneurysm rupture secondary to transcatheter embolization.False aneurysms of the pancreatic and peripancreatic arteries are a well recognized complication of chronic pancreatitis due to proteolytic enzymatic digestion of the arterial wall. These false aneurysms can be a source of life-threatening hemorrhage. Three cases are reported in which attempted embolizations of these bleeding aneurysms resulted in rupture into the gastrointestinal tract. Special precautions should be taken in such a procedure because of the inherent weakness of the aneurysmal wall.- - - - - - - - - - ranking = 0.66666666666667keywords = aneurysm (Clic here for more details about this article) |
9/98. Pitfall: a pseudo tumor within the left liver lobe presenting with abdominal pain, jaundice and severe weight loss.A 51 year old male patient with a history of chronic alcohol consumption and recurrent pancreatitis was referred to our hospital with jaundice, epigastric pain, severe diarrhoea and weight loss of 28 kg within the last 12 months. A CT scan of the abdomen 4 months before admission had shown a pancreatitis with free fluid around the corpus and tail of the pancreas as well as dilated intrahepatic bile ducts and a cavernous transformation of the portal vein. Moreover, a tumor (3.5 x 3.0 x 3.6 cm) with irregular contrast enhancement was seen within the left liver lobe. The patient was referred to us for further evaluation and treatment. The initial B-Mode sonogram revealed a bull's eye like well defined lesion (8.1 x 7.5 x 7.0 cm) within the left liver lobe, consistent with a tumour or abscess. Prior to a diagnostic needle biopsy a PTCD was performed in this case presenting with dilated intrahepatic bile ducts and having a history of Billroth II operation. An additional colour coded Duplex Doppler ultrasonography demonstrated a visceral artery aneurysm and prevented us from performing the diagnostic puncture. The aneurysm was assumed to originate from a variant or a branch of the left hepatic artery. angiography revealed a pseudoaneurysm of the pancreaticoduodenal artery and coil embolization was performed because of the increasing size and the risk of a bleeding complication. Postinterventional colour duplex ultrasound measurement showed no blood flow within the aneurysm. Retrospectively, the pseudoaneurysm must have led to a compression of the common bile duct, since the patient did not develop cholestasis after embolization and removal of the PTCD. Thus, a pseudoaneurysm of the pancreaticoduodenal artery must be included in the differential diagnosis of liver tumours in patients with chronic pancreatitis, despite its unusual localization near the liver. Therefore, we suggest that colour coded ultrasonography should be applied to any unclear, bull's eye like lesion, even though this method alone cannot exactly determine the origin of the pseudoaneurysm. Interventional angiography remains the gold standard for the diagnosis and therapy of visceral artery aneurysm.- - - - - - - - - - ranking = 32.940375519575keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
10/98. Hemosuccus pancreaticus complicating chronic pancreatitis: an obscure cause of upper gastrointestinal bleeding.BACKGROUND: Hemosuccus pancreaticus, a rare form of upper gastrointestinal bleeding, may complicate chronic pancreatitis and pose a significant diagnostic and therapeutic dilemma. AIM: To present our experience with this potentially life-threatening complication of chronic pancreatitis. methods: We reviewed our experience with management (both operative as well as angiographic embolization) of patients with hemosuccus pancreaticus complicating histologically documented chronic pancreatitis between 1976 and 1997. diagnosis of hemosuccus pancreaticus was based on clinical presentation, preoperative endoscopic and radiographic imaging, operative findings, and pathologic evaluation. RESULTS: During the period, we managed eight patients with hemosuccus pancreaticus (1.5% of all patients with chronic pancreatitis treated surgically). Gastrointestinal bleeding presented as hematemesis in three and hematochezia in three, but all had recent melena and were anemic; three of these patients were hemodynamically unstable. abdominal pain was present in six. When performed, angiography (n=6) was diagnostic of a pseudoaneurysm; computed tomography (n=7) showed a pseudoaneurysm in two and a pseudocyst in five. endoscopy (n=8) revealed blood issuing from the ampullary papilla in two patients. Operative management (n=6) involved distal pancreatectomy, pancreatoduodenectomy, or total pancreatectomy in two patients each. Angiographic embolization was successful in one patient, but the other died from uncontrollable hemorrhage. CONCLUSIONS: Hemosuccus pancreaticus is rare, but should be considered in patients with chronic pancreatitis and gastrointestinal bleeding. In the absence of pancreatitis-related indications for surgery, angiographic embolization can be definitive treatment. If there are pancreatitis-related indications for operation, angiographic embolization may allow an elective operative procedure based on structural changes of the pancreas. If embolization fails, pancreatic resection is usually required, often on an emergent basis.- - - - - - - - - - ranking = 16.136854426454keywords = pseudoaneurysm, aneurysm (Clic here for more details about this article) |
| | Next -> |