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Special Feature
March 2011

Image of the Month—Diagnosis

Arch Surg. 2011;146(3):366-367. doi:10.1001/archsurg.2011.15-b

During celiac arteriography, a splenic artery pseudoaneurysm (PSA) with a tight jet of contrast medium extravasation from the midsplenic artery was identified (Figure 2). Coil embolization was performed, with coils deployed at the site of contrast agent leak, eliminating the extravasation. The remaining hospital course was uneventful, with continued hemodynamic stability, improving abdominal tenderness, normalization of the serum lipase level, and a stable hemoglobin level. The patient tolerated a regular diet without difficulty and was discharged.

Chronic pancreatitis is traditionally associated with upper gastrointestinal bleeding originating from peptic ulcers, esophageal or gastric varices, and erosive gastritis. Alternatively, pseudocysts can erode into the splenic artery and cause gastrointestinal bleeding. Arterial PSAs in this patient population are rare but may present with potentially lethal hemorrhage. The mechanism for PSA formation in chronic pancreatitis is enzymatic erosion of the arterial walls triggered by an overall inflammatory reaction in the pancreas. Mortality rates due to peripancreatic vessel PSA have been reported to be as high as 40%, making early diagnosis and adequate treatment clinically important.1