Peripancreatic pseudoaneurysm refers to the formation of a pseudoaneurysm around the pancreatic gland. It is a rare but potentially lethal complication 5.
Formation of pseudoaneurysm can occur in as many as 10% of cases of pancreatitis. The time interval is variable, ranging from days to years after the acute episode.
The most common vessels affected are the splenic and gastroduodenal arteries.
Dedicated MDCT or MR angiography can depict the pseudoaneurysm as a well-delineated rounded structure originating from the donor artery. High-attenuation or high-signal-intensity thrombus may be seen within the sac on unenhanced CT scans and fat-suppressed T1-weighted MR images.
There may be features of haemorrhagic pancreatitis.
After contrast administration, the sac may fill with contrast material if it is not completely thrombosed. Conventional angiography remains the standard of reference and provides the capability of endovascular management.
Treatment and prognosis
Early detection and management are paramount given the high mortality associated with rupture. Initial treatment can be with emergency or elective surgery or with arterial embolisation 6. Mortality rate according to one recent study was at around 11% 6.
Recognised complications include:
- rupture: can occur into the peritoneum, adjacent hollow organs, pseudocyst, or pancreatic duct (haemosuccus pancreaticus)
- re-bleeding following embolisation
- if juxtapancreatic in location, a pseudoaneurysm can mimic a hypervascular pancreatic lesion
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