Thillai Manoj, Sethi Pulkit, Narayana Menon Ramachandran, Puthukudiyil Kader Nazar
Department of Surgical Gastroenterology and Liver transplantation, Amrita Institute of Medical sciences, Amrita vishwavidyapeetham, Ponekkara, Kochi, Kerala, India.
Department of Radiodiagnosis, Amrita Institute of Medical Sciences, Amrita vishwavidyapeetham, Ponekkara, Kochi, Kerala, India.
BMJ Case Rep. 2017 Apr 26;2017:bcr-2016-218891. doi: 10.1136/bcr-2016-218891.
Cystic artery pseudoaneurysm is a rare pathology. Of the 20 cases reported so far, chronic cholecystitis and iatrogenic biliary injury form the majority of causes. Currently, there is no published report of such pseudoaneurysms caused secondary to pancreatitis, hence the management in such a scenario is unclear. We hereby present the first such report of cystic artery pseudoaneurysm occurring as a sequel of acute necrotising pancreatitis. A 33-year-old man who recovered from a recent attack of acute pancreatitis was readmitted for melena and fever. Computed tomography of abdomen revealed blood in the gall bladder with pericholecystic blush and resolving pancreatic necrosis. Percutaneous transarterial embolisation of the cystic artery was done. This stabilised the patient but persistent sepsis and clinical deterioration warranted a surgical exploration and cholecystostomy. Hence, transarterial embolisation followed by surgery in selected cases can be an ideal management protocol.
胆囊动脉假性动脉瘤是一种罕见的病理情况。在迄今为止报道的20例病例中，慢性胆囊炎和医源性胆管损伤是主要病因。目前，尚无胰腺炎继发此类假性动脉瘤的公开报道，因此在这种情况下的治疗方法尚不清楚。我们在此首次报告一例急性坏死性胰腺炎继发胆囊动脉假性动脉瘤的病例。一名近期急性胰腺炎发作后康复的33岁男性因黑便和发热再次入院。腹部计算机断层扫描显示胆囊内有血液，胆囊周围有造影剂外溢，胰腺坏死正在消退。对胆囊动脉进行了经皮经动脉栓塞术。这使患者病情稳定，但持续的脓毒症和临床恶化促使进行手术探查并做了胆囊造口术。因此，在某些病例中，先进行经动脉栓塞术再进行手术可能是理想的治疗方案。
