Branquinho Diogo, Ramos-Andrade Daniel, Elvas Luís, Amaro Pedro, Ferreira Manuela, Sofia Carlos
Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
GE Port J Gastroenterol. 2016 Aug 12;23(6):309-313. doi: 10.1016/j.jpge.2016.06.002. eCollection 2016 Nov-Dec.
Rupture of pseudoaneurysms is rare but can be life-threatening complications of acute or chronic pancreatitis, usually due to enzymatic digestion of vessel walls crossing peripancreatic fluid collections. We report the case of a 40 year-old female, with multisystemic lupus and anticoagulated for prior thrombotic events, admitted for probable cyclosporine-induced acute pancreatitis. Hemodynamic instability occurred due to abdominal hemorrhage from two pseudoaneurysms inside an acute peri-pancreatic collection. Selective angiography successfully embolized the gastroduodenal and pancreatoduodenal arteries. The hemorrhage recurred two weeks later and another successful embolization was performed and the patient remains well to date. The decision to restart anticoagulants and to suspend cyclosporine was challenging and required a multidisciplinary approach. Despite rare, bleeding from a pseudoaneurysm should be considered when facing a patient with pancreatitis and sudden signs of hemodynamic instability.
假性动脉瘤破裂虽罕见，但可能是急性或慢性胰腺炎危及生命的并发症，通常是由于胰周液体积聚对穿过的血管壁进行酶性消化所致。我们报告一例40岁女性病例，患有多系统狼疮，因既往血栓事件接受抗凝治疗，因可能的环孢素诱导的急性胰腺炎入院。急性胰周积液内的两个假性动脉瘤导致腹腔出血，进而出现血流动力学不稳定。选择性血管造影成功栓塞了胃十二指肠动脉和胰十二指肠动脉。两周后出血复发，再次成功进行栓塞，患者至今情况良好。重启抗凝剂并停用环孢素的决定具有挑战性，需要多学科方法。尽管罕见，但面对胰腺炎患者出现血流动力学不稳定的突然征象时，应考虑假性动脉瘤出血的情况。
