Angiographic diagnosis and treatment of a splenic artery pseudoaneurysm following endoscopic cystogastrostomy for a pancreatic pseudocyst

Abstract

Summary of the Event: A 57-year-old male with chronic pancreatitis presented with an enlarging pseudocyst which was treated with endoscopic ultrasound (EUS)-guided cystogastrostomy. Three days later, he presented with massive hematemesis, and abdominal computed tomography (CT) revealed hemorrhage within both the pseudocyst and the stomach. Endoscopic evaluation was impossible due to the massive amount of hematemesis. Angiography delineated a small pseudoaneurysm with contrast extravasation involving the branch of the splenic artery. Embolization using n-butyl-2 cyanoacrylate was performed leading to the immediate cessation of bleeding. Teaching Point: The risk of delayed hemorrhage after EUS-guided cystogastrostomy for a pancreatic pseudocyst should always be kept in mind. Angiography should be considered for the diagnostic and therapeutic purpose when hemostasis is not possible using an endoscope.

Keywords

• aneurysm
• false; interventional ultrasonography; pancreatic pseudocyst; therapeutic embolizaiton