Management of bleeding pseudoaneurysms in patients with pancreatitis

Background: Bleeding pseudoaneurysm is a rare but frequently fatal complica tion in patients with pancreatitis. Method: The medical records of ten patients who presented to this instituti on with a bleeding pseudoaneurysm between 1978 and 1997 were reviewed retro spectively. Six patients had chronic pancreatitis and four had acute pancre atitis. The splenic artery was involved in six cases, a pancreaticoduodenal artery in two, the gastroduodenal artery in one and the cystic artery in o ne. Results: Computed tomography (CT) revealed the bleeding pseudoaneurysm in a ll patients (n = 6) with chronic pancreatitis but in only one of three with acute pancreatitis. Arteriography always gave the correct diagnosis. Seven patients underwent pancreatic resection as an emergency (n = 3) or within 48 h (n = 4), and survived. Three patients presenting with acute pancreatit is and massive bleeding underwent transcatheter arterial embolization. Two of them had a favourable outcome and one died from a recurrent haemorrhage 7 days later. Overall, two patients suffered significant perioperative comp lications and one died. Conclusion: CT is accurate in the diagnosis of pseudoaneurysms complicating pseudocysts. Primary resection of the pseudoaneurysm, which frequently req uires pancreatic resection, is the treatment of choice. Angiography followe d by transcatheter embolization is effective, but should be rapidly followe d by operation.