Pancreatitis visceral aneurysm

The majority of patients who develop significant bleeding as a complication of pancreatitis do so because of associated upper gastrointestinal ulceration and inflammation. Occasionally portal vein thrombosis can lead to variceal bleeding [4], Neither of these pathologies is within the remit of this chapter. The estimated incidence of visceral aneurysm development in patients with pancreati-... 

Pancreatitis associated visceral aneurysms are caused by the action of proteolytic enzymes, released... 

There is one further indication for thrombin occlusion of pancreatitis associated visceral aneurysms. Where the portal vein has occluded as a complication and the patient has a proximal splenic or gastroduodenal aneurysm, the proximal and distal coil embolization of which could compromise the hepatic arterial supply to the liver causing liver infarction, thrombin injection maybe a safer technique [29]. 

Visceral aneurysms are uncommon and most frequently involve the splenic artery. They may also arise from the pancreaticoduodenal branches of either the GDA or SMA and the left gastric artery (Fig. 14.3). Although an underlying cause may not he demonstrated, many of these are associated with acute or chronic pancreatitis or are secondary to atheromatous disease. Atheromatous stenosis of the coeliac axis or compression of the coeliac axis by the median arcuate ligament of the diaphragm results in hypertrophy of the pancreaticoduodenal arteries and is associated with aneurysm formation. 

Ultrasound is useful for many aspects of pancreatitis but has a sensitivity of less than 73% for visceral pseudoaneurysm in the condition, vdiereas contrast enhanced computer tomography (CECT) has a sensitivity of almost 100% [22]. CECT is also very useful in terms of endovascular treatment as it can indicate what type of aneurysm has formed, which artery it has formed from and whether there is more than one. 

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