We report the case of a 60-year-old man with a history of severe acute pancreatitis of biliary etiology, cholecystectomy, bronchial asthma.
Treatment with budesonide.
She came to the emergency room with localized pain in the right hypochondrium radiating to the renal f and right scapula of 2 weeks duration without oral analgesia.
Physical examination revealed a conscious, oriented patient with a feeling of disease, normohydrated and perfused.
TA 150/94, FC 70 bpm, Ta 36 oC.
Cardiorespiratory arrest was normal.
Abdomen: blushing, depressible, non-defensive scar, discomfort to complicated constipation in hypochondrium without defense or signs of peritonitis, increased biliary stricture, intestinal sounds 2
Lower extremities: no edemas or signs of deep venous thrombosis.
General analysis: 11,720 leukocytes/mm3 (75% PMN), glucose 140 mg/100 ml, total bilirubin 1.5 mg/dl, PCR 10.
Cholangioresonacia: areas of fibrosis in the body and tail with small pseudocysts at this level and a 4 mm pseudocyst in the pancreatic head compatible with chronic pancreatitis.
Abdominal CT: a synovial synovial artery is observed, appreciating at the level of the region of the tail of the pancreas an image of a mass of about 4.8 cm of true diameter, which seems to correspond to 3.5 cm a pseudoneurism.
Arteriography showed extravasation at the level of the middle third of the splenic artery and introduced microcatheter into the pseudoaneurysm cavity, embolizing by the introduction of several microcatheters
1.
After arteriography, the patient has melenic bowel movements, performing gastroscopy and voiding.
Scintigraphy with marked hema-ti showed deposits with weak intensity activity in the ileocecal area 19 hours after injection.
It was then decided to perform exploratory laparotomy and intraoperative enteroscopy finding four lesions in the ileum suggestive of angiodysplasia, resecting 20 cm of ileum and ileostomy in gunshot.
The patient, initially, ten days later, suffered a new episode of bleeding with hemodynamic repercussions. A new endoscopy was performed in order to locate the deformity and localize the new neck, performing a percutaneous suture.
After this, the patient progresses favorably, not presenting a new episode of bleeding so he is discharged.
