Visceral artery pseudoaneurysm in necrotizing pancreatitis: incidence and outcomes

Thomas K. Maatman, Mark A. Heimberger, Kyle A. Lewellen, Alexandra M. Roch, Cameron L. Colgate, Michael G. House, Attila Nakeeb, Eugene P. Ceppa, C. Max Schmidt, Nicholas J. Zyromski

Research output: Contribution to journalArticle

Abstract

Background: Visceral artery pseudoaneurysms (VA-PSA) occur in necrotizing pancreatitis; however, little is known about their natural history. This study sought to evaluate the incidence and outcomes of VA-PSA in a large cohort of patients with necrotizing pancreatitis. Methods: Data for patients with necrotizing pancreatitis who were treated between 2005 and 2017 at Indiana University Health University Hospital and who developed a VA-PSA were reviewed to assess incidence, presentation, treatment and outcomes. Results: Twenty-eight of 647 patients with necrotizing pancreatitis (4.3%) developed a VA-PSA between 2005 and 2017. The artery most commonly involved was the splenic artery (36%), followed by the gastroduodenal artery (24%). The most common presenting symptom was bloody drain output (32%), followed by incidental computed tomographic findings (21%). The median time from onset of necrotizing pancreatitis to diagnosis of a VA-PSA was 63.5 days (range 1-957 d). Twenty-five of the 28 patients who developed VA-PSA (89%) were successfully treated with percutaneous angioembolization. Three patients (11%) required surgery: 1 patient rebled following embolization and required operative management, and 2 underwent upfront operative management. The mortality rate attributable to hemorrhage from a VA-PSA in the setting of necrotizing pancreatitis was 14% (4 of 28 patients). Conclusion: In this study, VA-PSA occurred in 4.3% of patients with necrotizing pancreatitis. Percutaneous angioembolization effectively treated most cases; however, mortality from VA-PSA was high (14%). A high degree of clinical suspicion remains critical for early diagnosis of this potentially fatal problem.

Original languageEnglish (US)
Pages (from-to)E272-E277
JournalCanadian journal of surgery. Journal canadien de chirurgie
Volume63
Issue number3
DOIs
StatePublished - May 21 2020

ASJC Scopus subject areas

  • Surgery

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    Maatman, T. K., Heimberger, M. A., Lewellen, K. A., Roch, A. M., Colgate, C. L., House, M. G., Nakeeb, A., Ceppa, E. P., Schmidt, C. M., & Zyromski, N. J. (2020). Visceral artery pseudoaneurysm in necrotizing pancreatitis: incidence and outcomes. Canadian journal of surgery. Journal canadien de chirurgie, 63(3), E272-E277. https://doi.org/10.1503/cjs.009519