1/1488. Haemosuccus pancreaticus: a clinical challenge. BACKGROUND: Haemosuccus pancreaticus is a rare complication of pancreatitis. It is a diagnostic problem for even the most astute clinician and a challenge for the expert endoscopist. We report a 25-year-old male patient who had all the features usually seen in haemosuccus pancreaticus patients: recurrent obscure upper gastrointestinal bleeding, pancreatitis, pseudocyst formation, ductal disruption, fistula and pancreatic ascites. The patient was treated by subtotal pancreatectomy, splenectomy and drainage of the pseudocyst. Although pancreatic duct communication with the surrounding vasculature could not be ascertained, we strongly believe the patient had haemosuccus pancreaticus because, over a follow-up period of 3 years, the patient was not only ascites free, but did not experience any further upper gastrointestinal bleeding. We believe that in evaluating patients with recurrent obscure gastrointestinal bleeding, one should always remember that the pancreas is a part of the gastrointestinal tract and, like other organs, is prone to blood loss. ( info) |
2/1488. Crack-cocaine-associated aortic dissection in early pregnancy--a case report. Even though uncommon in pregnancy, aortic dissection is a potentially catastrophic vascular complication, occurring mainly in the late stages of pregnancy. Vascular events, including aortic dissection are recognized complications of crack-cocaine use. The authors report a case of aortic dissection in early pregnancy related to crack-cocaine use. They believe that the combined effects of pregnancy and crack cocaine on the vasculature create the requisite milieu potentiating such catastrophic events as aortic dissection. This paper reviews the possible underlying pathophysiologic mechanisms and the available diagnostic, therapeutic, and management options. ( info) |
3/1488. Repair of a pseudoaneurysm of the ascending aorta after aortic valve replacement. An elderly woman underwent an aortic valve replacement and 5 months later developed a pseudoaneurysm from the anterior aspect of the proximal ascending aorta (AA). The pseudoaneurysm was approached through a redo-median sternotomy, on cardiopulmonary bypass (CPB), mild hypothermia, and a beating heart, with a temporary fingertip occlusion of its ostium, and repaired successfully using mattress monofilament sutures enforced by pledgets. The standard approach to such pseudoaneurysms is a CPB and hypothermic circulatory arrest (HCA) prior to mid-sternotomy, and replacement of the AA. But, when a pseudoaneurysm arises from a narrow ostium on the anterior aspect of the AA, as in this case, it can be sutured closed with pledgets under CPB with a mild hypothermia and a beating heart. ( info) |
4/1488. Intrahepatic artery pseudoaneurysm: a possible complication of blind thoracentesis. We present a case of intrahepatic artery pseudoaneurysm that developed after blind thoracentesis in a 67-year-old man. This unusual complication demonstrates the value of sonographic guidance in reducing the risk of complications of thoracentesis. ( info) |
| Aortic pseudo-aneurysm is a rare manifestation of takayasu arteritis. We present a 16-year-old girl who first complained of multiple arthritis, recurrent abdominal pain and malaise at the age of 15 years. The initial working diagnosis was juvenile rheumatoid arthritis. Follow-up abdominal ultrasonography for her hepatomegaly incidentally revealed an aortic aneurysm. Total aortography showed diffuse aortic narrowing and an infra-renal aortic pseudo-aneurysm. Vascular reconstruction with an interposition Dacron graft was performed with uneventful recovery. Early non-specific presentation of takayasu arteritis often results in delay of diagnosis. The presence of a vascular bruit in a young female with non-specific symptoms should point to a differential diagnosis of takayasu arteritis. We review the role of surgery in the management of this condition. ( info) |
6/1488. Pseudoaneurysm of the profunda femoris artery due to intertrochanteric fracture of the hip. Arterial injury caused by hip fracture is a rare event. We report a case of pseudoaneurysm of the profunda femoris artery that presented 4 weeks after correction of an intertrochanteric hip fracture with a dynamic hip screw. The diagnosis was confirmed by Duplex ultrasound scanning, and it was treated by ligation of the profunda femoris artery at the level of the pseudoaneurysm. ( info) |
7/1488. Pseudoaneurysm of the left ventricle after isolated pericarditis and staphylococcus aureus septicemia. Left ventricular pseudoaneurysm after isolated pericarditis as a result of Staphylococcal septicemia is very rare. A case of a very young patient is described. diagnosis is made by echocardiography. Immediate surgical resection of the pseudoaneurysm is the therapy of choice. ( info) |
8/1488. Post-traumatic thoracic pseudoaneurysm repair with an endoluminal expandable stent. Recent technological improvement has allowed endoluminal correction of thoracic and abdominal aortic aneurysm through percutaneous insertion of expandable stents. A woman who presented with chronic pseudoaneurysm of the thoracic aorta 10 years after being in a car accident is presented. A Talent stent was introduced through the femoral artery and successfully deployed under fluoroscopic guidance across the aneurysmal defect. Recovery was uneventful, and 12 months later the patient remained asymptomatic. ( info) |
9/1488. Chronic traumatic aortic pseudoaneurysm: resolution with observation. Immediate operative repair is the most commonly recommended treatment for traumatic aortic ruptures, regardless of age or size of the lesion. We report a patient who presented with a large chronic aortic pseudoaneurysm and has been thus far managed nonoperatively with shrinkage of his lesion and no symptoms. ( info) |
10/1488. Pseudoaneurysm of the superficial femoral artery following accidental trauma: result of treatment by percutaneous stent-graft placement. Accidental trauma frequently involves the extremities, and can extend to involve their blood supply, causing exsanguinating hemorrhage and pseudoaneurysm in the involved blood vessel. This is traditionally managed by surgical repair. We report a case in which control of life-threatening hemorrhage and exclusion of a large, post-traumatic pseudoaneurysm in the superficial femoral artery was performed by a commercially available stent-graft, without complication. This treatment method may be a safe and effective alternative to surgery in selected patients. ( info) |