Left gastric artery aneurysm - 23/08/11
Doi : 10.1016/j.gie.2007.07.013
| Commentary This cirrhotic patient reminds us that, uncommonly, patients can have both liver and pancreatic disease from alcohol abuse and that we should not let technology eclipse our clinical appreciation that splenic artery pseudoaneurysm, gastric varices, and duodenal ulcer are the 3 major causes of pancreatitis-related upper GI bleeding. When you see an extrinsic mass indenting the stomach in an alcoholic, be it pulsatile or not, think pseudoaneurysm; the incidence of this complication of pancreatitis may be as high as 10%. The splenic artery is the most common artery to be involved, followed by the gastroduodenal and pancreaticoduodenal arteries and then any of the other splanchnic arteries. The pathogenesis of aneurysm formation with pancreatitis is poorly understood, but probably follows 2 pathways that ultimately may merge: (1) the inflammatory process can cause partial digestion of the arterial wall and result in focal dilation of the vessel, forming a true aneurysm; (2) the artery can be incorporated into the wall of a pseudocyst and with digestion of the arterial wall, the vessel ruptures into the pseudocyst, converting it into pseudoaneurysm. The incidence of gastroduodenal bleeding with pseudoaneurysm is low (approximately 2%) and, most commonly, bleeding is into the bowel followed by the peritoneal cavity, pancreatic duct, or biliary tree. Pseudoaneurysm may be treated by a variety of methods, including surgical repair, superselective embolization with microcoils or polyvinyl alcohol/gelatin sponge, or CT- or EUS (transgastric)-guided thrombin injected directly into the pseudoaneurysm. How much faster would definitive diagnosis and treatment have been rendered had a CT of the abdomen been done after the history was taken and the EGD performed? Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2008
American Society for Gastrointestinal Endoscopy. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
Vol 67 - N° 1
P. 154-155 - gennaio 2008 Ritorno al numero
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