Clinical Analysis of the Pseudoaneurysm of Chronic Pancreatitis

ABSTRACT

Arterial pseudoaneurysm is an infrequent but potentially catatrophic complication of pancreatitis. A pseudoaneurysm is encountered in 6~9.5% of patient with chronic pancreatitis and as many as 17% of all patients operated on for chronic pancreatitis. A ruptured pseudoaneurysm is the most fatal complication with reported mortality rate as low as 12.5% in treated patients, greater than 90% in patients not receiving treatment. Therefore bleeding pseudoanurysms are required early diagnosis and radical treatment. We reviewed 8 patients who were admitted to Department of Surgery of Chonnam University Hospital for treatment of pseudoaneurysm complicating chronic pancreatits from January, 1993 to December, 1997. The results were as follows. 1) The patiens were all male, and the age range was 30 to 65 years(mean 47 years). 2) The most prevalent symtom and sign were anemia and abdominal pain(100%). 3) Angiography and abdiminal CT were performed in all patients. 4) Pseudoaneurysms were located in gastroduodenal artery(4 cases), branch of superior mesenteric artery(2 cases), superior mesenteric artery(1 case) and pancreaticoduodenal artery(1 case). 5) Transarterial embolization was performed in 6 cases and reembolization was done in 1 case and 1 rebleeding case was expired. 6) Operative management(aneurysmorrhaphy) was performed without complication in 2 cases. We consider that complete resection of pseudoaneurysm complicating chronic pancreatitis is the treatment of choice but transarterial embolization using coil may be considered as the first method of treatment.