Introduction : Pseudoaneurysm of visceral arteries is uncommon and usually provoked by intraabdominal inflammary processes such as pancreatitis or cholecystitis , or by surgical trauma. Vascular complication of pancreatitis are major cause of morbidity & mortality, including haemorrhage from direct arterial erosion or pseudoaneurysm formation, splanchnic vein thrombosis and visceral ischemia . Pseudoaneurysm formation in pancreatitis might related to autodigestion of pancreatic enzymes, especially elastase, liberated due to pancreatitis.
Case report : This is a 53 y/o man denied of any previous systemic illness, suffered from epigastric discomfort with nausea off and on for about one month. Two days prior to our ED visit ,he suffered from severe progressive dull epigastric pain with backward radiation, not relieved by resting or antacid associated with nausea, vomiting sweating and poor appetite. Vital signs on arrival were respiration 20/min, pulse 93/min, blood pressure 151/101 mmHg, and BT 36.9 C. Abdomen was soft but with mild tenderness on epigastrium, hypoactive bowel sounds and otherwise unremarkable. Laboratory results were WBC 14600/mm3, Hb 14.9 g/dl , Hct: 46.8%, Neutrophil: 76.9%, CRP 5.388, Amylase: 672U/L , Lipase : 666U/L, lipid profile were within normal limits. Electrocardiogram was OK. Abdominal X-ray showed ileus with gas distension in small & large bowels Abdominal sonography showed pancreatic cystic tumor & and tumor markers revealed CA-199: 51.17, CEA: 1.57.. He was arranged with MRI of abdomen which revealed pancreatitis with suspect 2 pseudoaneurysms over hepatic artery. Multidetector-row computed tomography study confirmed the diagnosis.
Discussion : Hepatic artery pseudoaneurysm (HAP) is a serious complication of acute or chronic surgical injury to hepatic artery or after orthotopic liver transplantation. It is also seen following blunt and penetrating abdominal injury as well as in chronic pancreatitis. Hepatic artery pseudoaneurysms are rare, however fatal rupture is common and occurs in >70% of patients. Early radiological diagnosis and intervention is cornerstone. |