Post pancreatic tumor biopsy hemorrhage

Case contributed by Dr Pawel Piotrowicz

Presentation

Female patient with a significant deterioration of the general condition soon after fine needle biopsy of the pancreas due to probably malignant pancreatic tumor.

Patient Data

Age: 80 years
Gender: Female
CT

Multiphase abdominal CT scan

Moderate amount of relatively dense (around 25HU)  free peritoneal fluid.

Below the left hepatic lobe there is high density fluid collection (around 50HU) in keeping with a sentinel clot. In the arterial phase in the upper part of the collection contrast extravasation is visible due to active arterial bleeding from one of the branches of gastro-duodenal artery.

CT reveals also multiple hepatic metastases and hypodense focal lesion of the pancreatic head, best visible in the arterial phase. Lack of the contrast enhancement of the trunk and tail of the pancreas. Multiple sigmoid diverticula.

CT

CT scan, of the same patient, performed two weeks prior.

Examination reveals hepatic metastasis and pancreatic hed tumor as well as lack of the contrast enhancement of the trunk and tail of the pancreas.

There is no intraperitoneal fluid and no signes of active bleeding.

Case Discussion

During needle insertion into a pancreatic tumor one of the branches of the gasto-duodenal artery had been damaged.

CT was performed two hours after procedure, revealing active arterial bleeding. Conventional surgery was immediately performed so the vessel was occluded.

It is very important to carefully monitor patient after abdominal organ biopsy and in any unclear case perform immediate CT scan.

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Case information

rID: 60646
Published: 28th May 2018
Last edited: 31st May 2018
Inclusion in quiz mode: Included
Institution: Rydygier's Provincial Policlinic Hospital in Torun

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