Pseudoaneurysm of Splenic Artery - A Severe Vascular Complication of Pancreatitis

ABSTRACT

Acute pancreatitis is one of the common abdominal pathologies having an incidence of 10 to 100 cases per 100,000 population worldwide with varying type of presentation ranging from self-limiting abdominal pain to high mortality and morbidity due to organ failure. The major risk factors leading to pancreatitis include gall stones and alcohol consumption, others being trauma, drugs, and infections.1,2 The revised Atlanta classification (2012) has classified acute pancreatitis on the basis of local, systemic complications and organ failure as mild, moderately severe and severe type of pancreatitis. One of the dreaded local complications of pancreatitis are the vascular complications occurring with a frequency of 1.2 - 14 %, with a greater incidence seen in chronic pancreatitis (7 - 10 %) than acute pancreatitis (1 - 6 %). The two main types of vascular complications being splenic vein thrombosis (more common) and pseudo aneurysm of (in order of decreasing frequency) the splenic, gastro duodenal, and pancreaticoduodenal arteries.3,4 The common symptoms of pseudoaneurysm of splenic artery are abdominal pain, hematemesis, melena, flank pain, and chest pain. Haemorrhage from pseudo aneurysm can be found in the pseudo cyst, stomach, pancreatic duct, peritoneal cavity, or retro peritoneum making the patient highly haemodynamically unstable at presentation having high rates of morbidity and mortality.5 The mortality rate due to haemorrhages directly related to the pancreas is up to 50 %.2 Clinical diagnosis in these patients is highly difficult due to varied range of symptoms and hence ultrasound coupled with contrast enhanced CT imaging helps in accurate diagnosing of such an entity.Pancreatitis is one of the common abdominal pathologies having variable type of presentation. Vascular complications are rare, but severe in nature having high mortality and morbidity rates. Ultrasound coupled with computer tomography helps in fast and accurate diagnosis of these vascular complications like pseudo aneurysms, aneurysms and thrombosis of peri pancreatic arteries. We are presenting a case report of pseudoaneurysm of splenic artery.