PT  - JOURNAL ARTICLE
AU  - Thomas K. Maatman
AU  - Mark A. Heimberger
AU  - Kyle A. Lewellen
AU  - Alexandra M. Roch
AU  - Cameron L. Colgate
AU  - Michael G. House
AU  - Attila Nakeeb
AU  - Eugene P. Ceppa
AU  - C. Max Schmidt
AU  - Nicholas J. Zyromski
TI  - Visceral artery pseudoaneurysm in necrotizing pancreatitis: incidence and outcomes
AID  - 10.1503/cjs.009519
DP  - 2020 Jun 01
TA  - Canadian Journal of Surgery
PG  - E272--E277
VI  - 63
IP  - 3
4099  - http://canjsurg.ca/content/63/3/E272.short
4100  - http://canjsurg.ca/content/63/3/E272.full
SO  - CAN J SURG2020 Jun 01; 63
AB  - Background: Visceral artery pseudoaneurysms (VA-PSA) occur in necrotizing pancreatitis; however, little is known about their natural history. This study sought to evaluate the incidence and outcomes of VA-PSA in a large cohort of patients with necrotizing pancreatitis.Methods: Data for patients with necrotizing pancreatitis who were treated between 2005 and 2017 at Indiana University Health University Hospital and who developed a VA-PSA were reviewed to assess incidence, presentation, treatment and outcomes.Results: Twenty-eight of 647 patients with necrotizing pancreatitis (4.3%) developed a VA-PSA between 2005 and 2017. The artery most commonly involved was the splenic artery (36%), followed by the gastroduodenal artery (24%). The most common presenting symptom was bloody drain output (32%), followed by incidental computed tomographic findings (21%). The median time from onset of necrotizing pancreatitis to diagnosis of a VA-PSA was 63.5 days (range 1–957 d). Twenty-five of the 28 patients who developed VA-PSA (89%) were successfully treated with percutaneous angioembolization. Three patients (11%) required surgery: 1 patient rebled following embolization and required operative management, and 2 underwent upfront operative management. The mortality rate attributable to hemorrhage from a VA-PSA in the setting of necrotizing pancreatitis was 14% (4 of 28 patients).Conclusion: In this study, VA-PSA occurred in 4.3% of patients with necrotizing pancreatitis. Percutaneous angioembolization effectively treated most cases; however, mortality from VA-PSA was high (14%). A high degree of clinical suspicion remains critical for early diagnosis of this potentially fatal problem.