A 47-Year-Old Man With a History of Alcohol-Induced Chronic Pancreatitis

Juan Carlos Munoz, MD; William J. Salyers, Jr, MD, MPH

Disclosures

May 11, 2016

Although specific management of bleeding primarily involves interventional radiologic therapies, surgical intervention must be considered if less invasive strategies are unsuccessful at controlling bleeding. Surgical management includes arterial ligation of involved vessels as well as resection of the pancreatic head or tail and pseudocysts. Also, aneurysm resection with possible splenectomy may be indicated in cases of splenic artery aneurysms.[6,10,12] Additionally, both intraoperative ultrasonography and pancreatoscopy have been used in identifying the origin of bleeding during surgery.[6]

Selective angiography was performed on the patient in this case. The angiography revealed active arterial extravasation arising from the pancreaticoduodenal arcade. Coil embolization of the gastroduodenal artery was performed successfully. Follow-up images demonstrated excellent results, with significant stagnation of flow in the gastroduodenal artery and segmental branches without any significant arterial blush noted. Repeat angiography performed the following day demonstrated no further bleeding. The bleeding in this case was caused by vessel rupture within the pancreaticoduodenal arcade, most likely associated with the large pancreatic pseudocyst in the setting of chronic pancreatitis.

Although recent pseudocyst management may have played some role in the development of pseudohemobilia, the extent that each intervention contributed to the patient's presentation is uncertain. The patient remained clinically stable throughout the remainder of his hospital course and was discharged to home with continued outpatient follow-up of his chronic pancreatitis.

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