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Non-operative Management of Necrotic Pancreatic Collection and Bleeding Pseudoaneurysm Communicating with Bowel Lumen at Multiple Sites: a Case Report and Review of the Literature

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Roshan Razik1,2, Gary R. May1,3, Fred Saibil1,4

1) Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
2) Department of Health Policy and Management, Harvard School of Public Health, Boston MA, USA
3) Division of Gastroenterology, Therapeutic Endoscopy Program, St. Michael’s Hospital; and
4) Division of Gastroenterology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.251.cll


Pancreatic pseudocysts and foci of walled-off necrosis (WON) are well-known complications of acute pancreatitis. We present a case of severe gallstone pancreatitis complicated by WON, fistulization to the bowel and gastrointestinal bleeding. Bleeding was localized to a pseudoaneurysm of the gastroduodenal artery within the WON using imaging and endoscopy. Angiography and image-guided therapy were then used to control bleeding with coil-embolization. To our knowledge, this is the first report of non-operative management of a patient with severe pancreatitis complicated by WON and a bleeding pseudoaneurysm with multiple communications to the hollow viscera. Therapeutic options are discussed and a thorough literature review is included.

Key words: pseudocyst – pancreatitis – pseudoaneurysm – rupture – hemorrhage.

Abbreviations: EGD: esophagogastroduodenoscopy; ERCP: endoscopic retrograde cholangiopancreatography; GDA: gastroduodenal artery; GI: gastrointestinal; IEP: interstitial edematous pancreatitis; IPDA: inferior pancreaticoduodenal artery; WON: walled-off necrosis.