Superior pancreaticoduodenal artery pseudoaneurysm with subsequent hemosuccus pancreaticus: an unusual complication of chronic pancreatitis.

Abstract

The development of an arterial pseudoaneurysm is an unusual complication of chronic pancreatitis. The most commonly involved artery is the splenic artery. This is a case report describing a case of a superior pancreaticoduodenal artery pseudoaneurysm in a patient with chronic pancreatitis who developed hemosuccus pancreaticus. A 46-year-old man with history of binge ethanol intake presented to the emergency department with abdominal pain. A computed tomography (CT) scan showed features of chronic pancreatitis along with a 2 x 1.8 cm enhancing mass at the level of the pancreatic head, consistent with an arterial pseudoaneurysm in close proximity to the pancreatic duct as confirmed on endoscopic ultrasound. He underwent an endoscopic retrograde cholangiopancreatography in the context of a rise in his liver enzymes with the presence of gallbladder sludge. This was complicated by hemosuccus pancreaticus, which was successfully managed with percutaneous angioembolization. Despite its unusual incidence, pseudoaneurysm remains an important complication of chronic pancreatitis with a high mortality rate in case of acute hemorrhage. Diagnostic modalities include abdominal CT and Color Doppler ultrasound. Endovascular techniques are considered to be the first line of therapy in most cases. Early recognition and management of pancreatic pseudoaneurysms is important to avoid life-threatening hemorrhage.