A 56-year-old man was admitted to hospital because of upper abdominal pain and mild
fever for 2 weeks. One month previously, the patient had undergone resection of the
body and tail of the pancreas and splenectomy for pancreatic malignant tumor, and
2 weeks ago, the patient experienced abdominal pain with mild fever. Enhanced computed
tomography (CT) showed a blurred fat space in front of the pancreatic head and swelling
of the intestinal wall ([Fig. 1 a]). The symptoms gradually worsened and vomiting occurred a few days before admission.
Repeat CT showed a round, low-density mass (diameter 4.6 cm) near the pancreatic head
([Fig. 1 b]). Clinicians considered the diagnosis of pancreatic pseudocyst with infection. Endoscopic
ultrasonography (EUS)-guided cyst aspiration was planned.
Fig. 1 Enhanced computed tomography (CT). a A blurred, fat space in front of the pancreatic head was seen, with swelling of the
intestinal wall. b Repeat CT showed a round, low-density mass (diameter 4.6 cm) near the pancreatic
head.
Endoscopy revealed a large protuberance in the posterior wall of the antrum, several
ulcers on the surface ([Fig. 2]), and stenosis of the antrum. EUS showed an elliptical, uneven, hypoechoic mass
near the pancreatic head ([Fig. 3 a]), and fluid movement within the mass. Color Doppler ultrasound showed disorder of
blood flow within the mass ([Fig. 3 b]), and pulse Doppler ultrasound detected different types of blood flow ([Video 1]). A diagnosis of pseudoaneurysm was confirmed.
Fig. 2 Endoscopy revealed a large protuberance in the posterior wall of the antrum, with
several ulcers on the surface.
Fig. 3 Endoscopic ultrasound. a An elliptical, uneven, hypoechoic mass was seen near the pancreatic head, with fluid
movement within the mass. b Color Doppler showed disorder of blood flow within the mass.
Video 1 Pseudoaneurysm was diagnosed by endoscopic ultrasonography using color Doppler and
pulse Doppler.
The patient underwent emergency surgery. Massive hematemesis occurred after tracheal
intubation under general anesthesia. Immediate laparotomy confirmed a pseudoaneurysm
of the celiac artery trunk, which had ruptured into the gastric cavity; successful
repair was performed.
Pancreatic pseudoaneurysms are rare complications of acute or chronic pancreatitis
[1]. Surgery is another cause of pancreatic pseudoaneurysm [2]. The main clinical symptom is abdominal or digestive tract hemorrhage, with a high
mortality rate. Contrast-enhanced CT angiography and digital subtraction angiography
are the main methods used to diagnose pancreatic pseudoaneurysm [3]. EUS is also an effective method of diagnosis.
Endoscopy_UCTN_Code_CCL_1AZ_2AO
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