Severe acute pancreatitis evolving with rupture of a splenic artery pseudoaneurysm in a pediatric patient

Abstract

Introduction: Acute pancreatitis is a clinic condition due to a pancreatic and peripancreatic inflammatory process and it can evolve with severe complications. Case report: A seven-year-old male patient was diagnosed with severe acute pancreatitis, evolving with walled of necrosis and rupture of splenic artery pseudoaneurysms, presenting with hemorrhagic shock. The patient was treated with percutaneous embolization and laparotomy with removal of the necrotic tissue, being discharged from the hospital 30 days after the surgery. Discussion: Acute pancreatitis must always be thought of as an important differential diagnosis in cases of acute abdominal pain. Despite adequate therapy, acute pancreatitis may progress with systemic or local complications. One of the most feared complications of both acute and chronic pancreatitis is the formation of pseudoaneurysms of visceral arteries, occurring in 0.05% of cases of acute pancreatitis, which can lead to massive hemorrhage, with a 25–50% mortality. This complication can be dealt with by percutaneous embolization, which was only partially successful in the present case, since the child underwent a laparotomy to completely control the bleeding. Conclusion: We recommend that, faced with sudden hemodynamic instability in patients with acute pancreatitis, the hypothesis of arterial pseudoaneurysm rupture should be evaluated.

Keywords

• Acute pancreatitis
• Children
• Arterial pseudoaneurysm
• Walled of necrosis