A case of pseudoaneurysm within the pseudocyst of chronic pancreatitis

Abstract

Pancreatic pseudocyst can be a surgical complication of chronic pancreatitis. The pseudocyst contains digestive enzymes that can cause damage to the arterial wall resulting in rapid growth of the pseudocyst and abdominal pain. Rupture of a pseudoaneurysm into abdominal cavity or gastrointestinal tract can be fatal.
We describe a patient with pseudoaneurysm within the pseudocyst detected by intraoperative ultrasonography. A 56-year-old man was diagnosed as acute pancreatitis. He could not abstain from drinking and was diagnosed as chronic pancreatitis and pancreatic pseudocyst on CT scan six years later. Acute exacerbation and formation of a pseudocyst with organized necrosis was suspected before operation. Intraoperative ultrasonography revealed, however, a large pseudocyst within the pancreatic body and dynamic whirling arterial flow inside of an organized mass in the pseudocyst. Distal pancreatectomy and pancreaticojejunostomy after the DuVal procedure was successfully performed. The specimen revealed a splenic artery-formed pseudoaneurysm within an organized blood clot within the pseudocyst. Careful preoperative assessment of pseudoaneurysms should be made before performing any type of drainage procedure.