MULTIDISCIPLINARY APPROACH TO PSEUDOANEURYSMS COMPLICATING PANCREATICPSEUDOCYSTS - IMPACT OF PRETREATMENT DIAGNOSIS

Objective: To determine the effectiveness of thin-section, dynamic-con trast computed tomography and angiography in detecting the presence of pancreatic pseudoaneurysms. Design: This case series consisted of 57 patients who were being examined for endoscopic drainage of pancreatic pseudocysts. Setting: All patients were examined in a tertiary care, teaching hospital. Patients: Fifty-seven consecutive patients were exa mined for 2 years. Follow-up ranged from 6 months to 2 years. Interven tions: All patients underwent thin-section, highspeed, dynamic-contras t computed tomography. Those patients with findings that were consiste nt with the presence of a pseudoaneurysm underwent angiography. Emboli zation was attempted if a pseudoaneurym was present. Endoscopic retrog rade cholangiopancreatography was used to determine pancreatic ductal anatomy before operation. Main Outcome Measure: No undetected pseudoan eurysm has complicated this series of endoscopically drained pseudocys ts. Results: Five patients had findings that were consistent with a pa ncreatic pseudoaneurysm on computed tomography. Angiographic findings confirmed a pseudoaneurysm in four patients, and angiographic emboliza tion was successful in three. Four patients underwent resection, while one was treated with embolization and endoscopic stenting of a compre ssed pancreatic duct. There were no mortalities. Conclusions: Before e ndoscopic drainage of a pancreatic pseudocyst, a thin-section, high-sp eed, dynamic-contrast computed tomographic scan is essential. If there are findings consistent with the development of a pseudoaneurysm, ang iography must be performed. This allows delineation of the arterial an atomy, as well as the option of performing angiographic embolization. While patients with pseudoaneurysms in the body and tail of the pancre as underwent resection, angiographic embolization alone was an accepta ble alternative when the lesion was located in the head of the pancrea s.