47 year old male with type II diabetes.
Drinker diagnosed with chronic pancreatitis.
She came to the emergency room with epigastric pain, nausea and vomiting.
On examination, the abdomen is blushing and depressible, with no signs of peritoneal irritation or laboratory abnormalities.
The patient was under observation and a CT scan showed chronic pancreatitis with multiple calcifications.
There are two formations in the pancreas: an 11 cm diameter in the tail compatible with a pseudocyst and a 2 cm solid aspect in the head corresponding to a pseudoaneurysm of the gastroduodenal artery.
Achievement was favorable and pain improved slightly.
Ten days later, the patient developed severe abdominal pain associated with vomiting and massive rectal bleeding.
Hemodynamic shock subsequently improves pain and persists bleeding.
A new CT scan showed the disappearance of the pseudocyst of the tail and an increase in the mass of the pancreatic head with signs of active arterial bleeding inside.
The picture is interpreted as a spontaneous drainage of the pseudocyst into the gastric cavity and digestive bleeding caused by the pseudoaneurysm in communication through the pseudocyst with the digestive tract.
This situation discourages the transfer and is surgically intervened.
1.
A mass in the size of a fist at the level of the pancreatic head was observed during surgery.
The gastroduodenal artery that binds at the origin is approached to stop the main source of blood that feeds the aneurysm.
A gastrotomy is performed to prove the communication of the pseudocyst of the tail with the posterior gastric wall and proving that there is no bleeding.
The evolution is favorable.
A few days after the intervention, after having replaced the hematocrit in the first hours, a progressive decrease in hemoglobin values was observed, so the patient was referred to the interventional radiology unit.
Selective arteriography is performed, in which the pseudoaneurysm cannot be accessed through the main artery that settles the defect, which is the gastroduodenal artery, and secondary pancreatic branch arteriography is performed.
The pseudoaneurysm was completely excluded.
In the following days the patient remains stable and there is no evidence of new signs of bleeding.
After six months the patient is asymptomatic.
