Hepatic Infarction Complicating Acute Pancreatitis: A Case Report

Hepatic infarction is relatively uncommon and is usually related to surgery or interventional procedures. Pancreatitis-associated hepatic infarction has not been reported in the literature, and we now describe a case of hepatic infarction in a 31-year-old man with acute pancreatitis. Initial CT scanning demonstrated an enlarged pancreas with multifocal fluid collection, and a large wedge-shaped low attenuation lesion was seen in the right lobe of the liver along with thrombi in the posteroinferior branch of the right portal vein. Hepatic arteri-ography and SMA portography revealed a pseudoaneurysm in the right hepatic artery, thrombi in the main portal vein and its posteroinferior branch, and perfusion defects confined to S6 of the liver.

Transcatheter Arterial Embolization of Splanchnic Arterial Pseudonaneurysm: Focus on the Method of Embolization

PURPOSE: To evaluate the effectiveness of transarterial embolization of splanchnic arterial pseudoaneurysm and to analyze the embolization technique. MATERIALS AND METHODS: Between 1991 and 1999, 38 patients with splanchnic arterial pseudoaneurysm underwent tarnsarterial coil embolization. The parent artery was embolized just distal and proximal to the neck of the pseudoaneurysm in 26 cases, and proximal to the aneurysmal neck in nine. In four patients, embolization involved the use of gelfoam, and in the other two patients, coil packing of the pseudoaneurysm sac was performed. RESULTS: Initial bleeding was controlled in 34 of the 38 patients (89%) treated by transarterial embolization (in 24 of 26 who underwent distal and proximal embolization, in seven of nine whose treatment involved proximal embolization and in two of four in whom gelfoam embolization was undertaken). In seven patients (18%), rebleeding occurred within 0 -14 (mean, 6.4) days of initial embolization. In two cases, bleeding reoccurred from the same artery initially treated by gelfoam embolization, in two others from that in which coil packing of the pseudoaneurysmal sac had been performed, and in three, from a different artery. Among these seven patients, one died from bleeding and the remaining six were successfully treated by repeated embolization. In spite of successful bleeding control, nine patients (24%) died of subsequent bleeding-related complications, namely sepsis (n=4), acute respiratory failure (n=3), and multi-organ failure (n=2). CONCLUSION: For the treatment of splanchnic arterial Pseudoaneurysm, transarterial embolization was a relatively simple and effective procedure. Proximal and distal coil embolization at the pseudoaneurysmal neck successfully isolated the of pseudoaneurysm and prevented the recanalization of blood flow.

Ultrasound-guided Compression Repair of pseudoaneurysms and

PURPOSE: For the treatment of arterial lesions occurring after catheterization, ultrasound-guided compressionrepair (UGCR) has recently been introduced. Using this technique, we repeatedly attempted treatment of theselesions and assessed their characteristics, as seen on US. MATERIALS AND METHODS: We prospectively studied 21patients who had suffered arterial injury (16 pseudoaneurysms and five arteriovenous fistulae) during arterialcatheterization. Occlusion of one pseudoaneurysm (PA) occurred spontaneously. UGCR was attempted in 20 casesinvolving arterial injury, including two which had occurred five months earlier. In six lesions, multiple attemptswere necessary. RESULTS: UGCR was successful in 18 (90%) of 20 arterial injuries, and all 15 PAs weresuccessfully treated;eight were completely closed at the first attempt, five were seen on follow-up US to havebeen closed after the first attempt, and two were completely closed at the second attempt. Three of fiveateriovenous fistulae (AVF) were successfully closed, one was completely closed at the first attempt, and two atthe second attempt. Mean compression time was 37(range:3-75)min in AVFs. Mean diameter of the cavity of PAs was3.8(range:1.5-10)cm;mean width of the track was 2.6(range:1-5)mm in PAs and 3.8(range:1.6-8)mm in AVFs. CONCLUSION: USGC can be successful after multiple attempts, even in patients with large cavity lesions and in chronic cases.AVFs with wide necks need a longer compression time and the results of the procedure are poorer.

Radiological Findings and Interventions for Iatrogenic Vascular Injuries

PURPOSE: To evaluate the radiological findings and effectiveness of radiological interventions in patientswith iatrogenic vascular injuries. MATERIALS AND METHODS: We analyzed 50 patients with iatrogenic vascularinjuries treated with radiological intervention. The causes of injuries were surgery(n=20), cardiovascularintervention(n=15), non-cardiovascular radiological intervention(n=14), and endoscopic intervention(n=1). Theinjury had resulted in hemorrhage in 35 cases. The iliac and/or femoral, hepatic, and renal vessels were commonlyinjured. Angiography, ultrasonography with Doppler examination, CT, and CT angiography were performed to diagnosevascular injuries and guide the radiological intervention. The mean follow-up period was 23 months and in 16 caseswas more than one year. RESULTS: The major radiological findings were extravasation, pseudoaneurysm,arteriovenous shunt, or vascular obstruction. To control these lesions, radiological interventions such asembolization(n=36), local urokinase administration, stent insertion, foreign body removal, ultrasonography-guidedcompression, or stent-graft insertion were performed. The clinical problems were immediately controlled by thesingle trials of radiological interventions and did not recur in 40 cases (80%). CONCLUSION: Radiologicalexaminations and interventions are useful in cases with iatrogenic vascular injuries.

Transcatheter embolization for splanchnic pseudoaneurysm

PURPOSE: To determine the therapeutic effect of transcatheter embolization in the treatment of splanchnicpseudoaneurysm. MATERIALS AND METHODS: This study involved eleven patients who underwent embolization for thetreatment of splanchnic pseudoaneurysm. Nine were men and two were women ; their ages ranged from 8 to 74 (mean,51) years. The etiology of these cases included postoperative pseudoaneurysm(n=4), pancreatitis(n=3), stabinjury(n=1), and suspected infection(n=1), while two cases were uncertain. The locations of the pseudoaneurysmwere the splenic artery(n=4), the gastroduodenal artery(n=3), the hepatic artery(n=2), the celiac artery(n=1), andboth the right renal and lumbar artery(n=1). All patients underwent angiography prior to embolization. Thematerials used during embolization were a microcoil, a 5-cm metallic guide wire, and a detachable balloon. RESULTS: Embolization was successful in all eleven cases. Among nine cases in which follow-up was possible, angiographywas performed in four, and five cases of thrombus were confirmed by abdominal CT. Three of these nine patientsunderwent re-embolization. One patient underwent elective surgery for a pseudocyst due to pancreatitis. CONCLUSION: Transcatheter embolization is a safe and convenient modality for the treatment of splanchnic pseudoaneurysm.

Splanchnic Artery Pseudoaneurysm: Transcatheter Embolization

PURPOSE: To evaluate the therapeutic effect and difficulty of embolization of pseudaneurysm of the splanchnic artery. MATERIALS AND METHODS: Between February 1988 and June 1996, we employed transcatheter embolization to treat a total of eleven patients with splanchnic artery pseudoaneurysm by transcatheter embolization. Eight were males and three were females ; their ages ranged from four to 70 years (mean 44). Three patients had previously been operated on, three had undergone biopsy, and on three, percutaneous transhepatic biliary drainage had been performed ; one had been involved in a traffic accident and one had suffered a gun-shot wound. All patients underwent diagnostic angiography and superselective embolization using a 3F microcatheter. We used Gelfoam with microcoil four times, microcoil twice, Gelfoam once, Gelfoam with ethanol once, a detachable balloon once, and Ivalon once. RESULTS: Arteries in which pseudoaneurysm had occurred were as follows: renal, four, hepatic, three; gastroduodenal, two ; superior mesenteric, one. Nine patients underwent one session of procedure and two underwent two session. Nine patients (82%) were treated successfully and without complication by embolization. Two patients failed to embolize due to vascular spasm and tortuosity in one and a wide aneurysmal neck in the other ; one of these died six days later and the other was operated on. CONCLUSION: Although there are therapeutic difficulties in cases of vascular spasm, tortuosity, or a wide aneurysmal neck, embolization of pseudoaneurysm of the splanchnic artery is a safe and effective life-saving procedure.