ISSN: 1899-0967
Polish Journal of Radiology
Established by prof. Zygmunt Grudziński in 1926 Sun
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1/2021
vol. 86
 
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Gastrointestinal and abdominal radiology
abstract:
Case report

Successful endovascular embolization of a giant splenic artery pseudoaneurysm secondary to a huge pancreatic pseudocyst with concomitant spleen invasion

Antonio Borzelli
1
,
Francesco Amodio
1
,
Francesco Pane
2
,
Milena Coppola
2
,
Mattia Silvestre
1
,
Marco Di Serafino
3
,
Fabio Corvino
1
,
Francesco Giurazza
1
,
Raffaella Niola
1

1.
Department of Vascular and Interventional Radiology, AORN “A. Cardarelli”, Napoli, Italy
2.
Department of Radiology, AORN “S.G. Moscati”, Avellino, Italy
3.
Department of General and Emergency Radiology, AORN “A. Cardarelli”, Napoli, Italy
Pol J Radiol 2021; 86: e489-e495
Online publish date: 2021/08/18
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Pseudoaneurysms of the pancreatic and peripancreatic arteries is a well-known complication of chronic or necrotizing pancreatitis due to proteolytic enzymatic digestion of the arterial wall. A major part of peripancreatic pseudoaneurysms involve the splenic artery, but any peripancreatic artery may be involved and bleed. They are potentially life threatening for patients, due to spontaneous intraperitoneal rupture, rupture and fistulization into the surrounding organs, or fistulization into the pancreatic duct. Small ones are usually asymptomatic and are often diagnosed incidentally, while giant (> 5 cm) aneurysms and pseudoaneurysms are symptomatic and may be detected as a pulsatile mass in the upper-left quadrant or epigastrium. Imaging plays a key role in the identification of splenic artery aneurysms and pseudoaneurysms, while angiography still represents the gold standard for the diagnosis, although nowadays it plays a prominent role in treatment. Treatment of splenic artery pseudoaneurysms is mandatory because of the high probability of rupture, with a mortality rate of up to 90%. The gold standard treatment is represented by surgery, with a mortality rate between 16% and 50%. In recent years the endovascular approach has proven to be an effective alternative treatment for splenic artery pseudoaneurysms, and it is currently the method of choice. In this article, we present the case of a ant pseudoaneurysm of the splenic artery due to huge pseudocysts in a young alcoholic patient with recurrent and chronic pancreatitis, complicated by fistulization and invasion of spleen parenchyma and arterio-venous fistula.
keywords:

pseudoaneurysm, chronic pancreatitis, endovascular embolization, splenic artery




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