PMC6334183_01
Contrast-enhanced computed tomography obtained one week after the patient's hospital admission demonstrated pancreatitis with acute necrotic collection and multiple pseudoaneurysms in the pancreatic head, body, and tail (arrow)
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A 50-year-old man admitted to our hospital for alcohol-induced acute pancreatitis with elevated serum amylase (1756 U/l) underwent contrast-enhanced computed tomography (CECT) one week after admission, which demonstrated necrosis of the pancreatic body with acute necrotic collection (ANC) and multiple pseudoaneurysms in the pancreatic head, body, and tail (Figure 1).
Selective embolisation for the aneurysm in the pancreatic body (arrow) fed by the dorsal pancreatic artery arising from the proximal portion of the superior mesenteric artery failed
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Initial TAE of the pseudoaneurysms in the pancreatic head supplied from the gastroduodenal artery and the pancreatic tail supplied from the splenic artery utilising coils and n-Butyl cyanoacrylate was successful, but one remaining aneurysm in the pancreatic body fed by the dorsal pancreatic artery arising from the proximal portion of the superior mesenteric artery could not be embolised because selective cannulation into the dorsal pancreatic artery had failed (Figure 2).
Direct puncture by a 21-gauge needle under fluoroscopy guidance demonstrated perfusion of the fluid collection surrounding the aneurysm, main pancreatic duct (arrowhead), and duodenum (arrow)
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ANC and main pancreatic duct instead (Figure 3) and attempted to puncture the pseudoaneurysm under CT guidance in the same way. Although placement of the puncture needle adjacent to the pseudoaneurysm prevented any appearance at its tip of arterial backflow from the outer cannula, we confirmed distribution of the injected diluted contrast media into the ANC surrounding the aneurysm rather than into the parent arteries, such as the celiac artery, and then injected about 500 units of thrombin (Fuji Pharma Co., Ltd., Tokyo, Japan) through the outer cannula (Figure 4).
A) Direct puncture under computed tomography guidance for the enlarged pseudoaneurysm. B) The tip of the puncture needle was located immediately adjacent to the aneurysm. C) The injected contrast media and thrombin distributed in fluid collection around the aneurysm (arrow)
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ANC and main pancreatic duct instead (Figure 3) and attempted to puncture the pseudoaneurysm under CT guidance in the same way. Although placement of the puncture needle adjacent to the pseudoaneurysm prevented any appearance at its tip of arterial backflow from the outer cannula, we confirmed distribution of the injected diluted contrast media into the ANC surrounding the aneurysm rather than into the parent arteries, such as the celiac artery, and then injected about 500 units of thrombin (Fuji Pharma Co., Ltd., Tokyo, Japan) through the outer cannula (Figure 4).
Contrast-enhanced computed tomography demonstrated shrinkage of the aneurysm just after the procedure (A) and its disappearance after 5 days (B)
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Relative to the appearance of the pseudoaneurysm in the pancreatic body on preoperative imaging, CECT obtained just after the procedure showed its shrinkage without complication, such as thrombosis of the parent artery, and it had completely disappeared on CECT obtained five days after the procedure (Figure 5).