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Multidisciplinary Approach to Pseudoaneurysms Complicating Pancreatic Pseudocysts: Impact of Pretreatment Diagnosis

Multidisciplinary Approach to Pseudoaneurysms Complicating Pancreatic Pseudocysts: Impact of... Abstract Objective: To determine the effectiveness of thin-section, dynamic-contrast computed tomography and angiography in detecting the presence of pancreatic pseudoaneurysms. Design: This case series consisted of 57 patients who were being examined for endoscopic drainage of pancreatic pseudocysts. Setting: All patients were examined in a tertiary care, teaching hospital. Patients: Fifty-seven consecutive patients were examined for 2 years. Follow-up ranged from 6 months to 2 years. Interventions: All patients underwent thin-section, high-speed, dynamic-contrast computed tomography. Those patients with findings that were consistent with the presence of a pseudoaneurysm underwent angiography. Embolization was attempted if a pseudoaneurym was present. Endoscopic retrograde cholangiopancreatography was used to determine pancreatic ductal anatomy before operation. Main Outcome Measure: No undetected pseudoaneurysm has complicated this series of endoscopically drained pseudocysts. Results: Five patients had findings that were consistent with a pancreatic pseudoaneurysm on computed tomography. Angiographic findings confirmed a pseudoaneurysm in four patients, and angiographic embolization was successful in three. Four patients underwent resection, while one was treated with embolization and endoscopic stenting of a compressed pancreatic duct. There were no mortalities. Conclusions: Before endoscopic drainage of a pancreatic pseudocyst, a thin-section, high-speed, dynamic-contrast computed tomographic scan is essential. If there are findings consistent with the development of a pseudoaneurysm, angiography must be performed. This allows delineation of the arterial anatomy, as well as the option of performing angiographic embolization. While patients with pseudoaneurysms in the body and tail of the pancreas underwent resection, angiographic embolization alone was an acceptable alternative when the lesion was located in the head of the pancreas.(Arch Surg. 1996;131:278-283) References 1. O'Malley VP, Cannon JP, Postier RG. Pancreatic pseudocysts: cause, therapy, and results . Am J Surg . 1985;150:680-682.Crossref 2. Becker JM. Pancreatic pseudocyst . In: Cameron JL, ed. Current Surgical Therapy . St Louis, Mo: Mosby—Year Book: 1992. 3. Bradley EL, Clements JL, Gonzalez AC. The natural history of pancreatic pseudocysts: a unified concept of management . Am J Surg . 1979;137:135-141.Crossref 4. Pitkaranta P, Haapiainen R, Kivisaari L, Schröder T. Diagnostic evaluation and aggressive surgical approach in bleeding pseudoaneurysms associated with pancreatic pseudocysts . Scand J Gastroenterol . 1991;26:58-64.Crossref 5. Adams DB, Zellner JL, Anderson MC. Arterial hemorrhage complication pancreatic pseudocysts: role of angiography . J Surg Res . 1993;54:150-156.Crossref 6. El Hamel A, Parc R, Adda G, Bouteloup PY, Huguet C, Malafosse M. Pseudoaneurysms in chronic pancreatitis . Br J Surg . 1991;78:1059-1063.Crossref 7. Stanley JC, Frey CF, Miller TA, Lindenauer SM, Child CG. Major arterial hemorrhage: a complication of pancreatic pseudocysts and chronic pancreatitis . Arch Surg . 1976;111:435-440.Crossref 8. Yeo CJ, Bastidas JA, Lynch-Nyhan A, Fishman EK, Zinner MJ, Cameron JL, The natural history of pancreatic pseudocysts documented by computed tomography . Surg Gynecol Obstet . 1990:170:411-417. 9. Warshaw AL, Rattner DW. Timing of surgical drainage for pancreatic pseudocyst . Ann Surg . 1985;202:720-724.Crossref 10. Cremer M, Deviere J, Engelholm L. Endoscopic management of cysts and pseudocysts in chronic pancreatitis: long-term follow-up after 7 years of experience . Gastrointest Endosc . 1989;35:1-9.Crossref 11. Donnelly PK, Lavelle J, Carr-Locke D. Massive hemorrhage following endoscopic transgastric drainage of pancreatic pseudocysts . Br J Surg . 1990;77: 758-759.Crossref 12. Gadacz TR, Trunkey D, Kieffer RF. Visceral vessel erosion associated with pancreatitis . Arch Surg . 1978;113:1438-1440.Crossref 13. Bluett MK, Bean D, Powers TA, O'Leary JP. Combined computerized tomography and angiography in evaluation of hemorrhage into pancreatic pseudocysts . South Med J . 1987;80:253-255.Crossref 14. Eckhauser FE, Stanley JC, Zelenack GB, Borlaza GS, Freier DT, Lindenauer SM. Gastroduodenal and pancreaticoduodenal artery aneurysms: a complication of pancreatitis causing spontaneous gastrointestinal hemorrhage . Surgery . 1980; 88:335-344. 15. Stabile BE, Wilson SE, Debas HT. Reduced mortality from bleeding pseudocysts and pseudoaneurysms caused by pancreatitis . Arch Surg . 1983;118:45-51.Crossref 16. Bresler L, Boissel P. Grosdidier J. Major hemorrhage form pseudocysts and pseudoaneurysms caused by chronic pancreatitis: surgical therapy . World J Surg . 1991;15:649-653.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Multidisciplinary Approach to Pseudoaneurysms Complicating Pancreatic Pseudocysts: Impact of Pretreatment Diagnosis

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1996.01430150056012
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To determine the effectiveness of thin-section, dynamic-contrast computed tomography and angiography in detecting the presence of pancreatic pseudoaneurysms. Design: This case series consisted of 57 patients who were being examined for endoscopic drainage of pancreatic pseudocysts. Setting: All patients were examined in a tertiary care, teaching hospital. Patients: Fifty-seven consecutive patients were examined for 2 years. Follow-up ranged from 6 months to 2 years. Interventions: All patients underwent thin-section, high-speed, dynamic-contrast computed tomography. Those patients with findings that were consistent with the presence of a pseudoaneurysm underwent angiography. Embolization was attempted if a pseudoaneurym was present. Endoscopic retrograde cholangiopancreatography was used to determine pancreatic ductal anatomy before operation. Main Outcome Measure: No undetected pseudoaneurysm has complicated this series of endoscopically drained pseudocysts. Results: Five patients had findings that were consistent with a pancreatic pseudoaneurysm on computed tomography. Angiographic findings confirmed a pseudoaneurysm in four patients, and angiographic embolization was successful in three. Four patients underwent resection, while one was treated with embolization and endoscopic stenting of a compressed pancreatic duct. There were no mortalities. Conclusions: Before endoscopic drainage of a pancreatic pseudocyst, a thin-section, high-speed, dynamic-contrast computed tomographic scan is essential. If there are findings consistent with the development of a pseudoaneurysm, angiography must be performed. This allows delineation of the arterial anatomy, as well as the option of performing angiographic embolization. While patients with pseudoaneurysms in the body and tail of the pancreas underwent resection, angiographic embolization alone was an acceptable alternative when the lesion was located in the head of the pancreas.(Arch Surg. 1996;131:278-283) References 1. O'Malley VP, Cannon JP, Postier RG. Pancreatic pseudocysts: cause, therapy, and results . Am J Surg . 1985;150:680-682.Crossref 2. Becker JM. Pancreatic pseudocyst . In: Cameron JL, ed. Current Surgical Therapy . St Louis, Mo: Mosby—Year Book: 1992. 3. Bradley EL, Clements JL, Gonzalez AC. The natural history of pancreatic pseudocysts: a unified concept of management . Am J Surg . 1979;137:135-141.Crossref 4. Pitkaranta P, Haapiainen R, Kivisaari L, Schröder T. Diagnostic evaluation and aggressive surgical approach in bleeding pseudoaneurysms associated with pancreatic pseudocysts . Scand J Gastroenterol . 1991;26:58-64.Crossref 5. Adams DB, Zellner JL, Anderson MC. Arterial hemorrhage complication pancreatic pseudocysts: role of angiography . J Surg Res . 1993;54:150-156.Crossref 6. El Hamel A, Parc R, Adda G, Bouteloup PY, Huguet C, Malafosse M. Pseudoaneurysms in chronic pancreatitis . Br J Surg . 1991;78:1059-1063.Crossref 7. Stanley JC, Frey CF, Miller TA, Lindenauer SM, Child CG. Major arterial hemorrhage: a complication of pancreatic pseudocysts and chronic pancreatitis . Arch Surg . 1976;111:435-440.Crossref 8. Yeo CJ, Bastidas JA, Lynch-Nyhan A, Fishman EK, Zinner MJ, Cameron JL, The natural history of pancreatic pseudocysts documented by computed tomography . Surg Gynecol Obstet . 1990:170:411-417. 9. Warshaw AL, Rattner DW. Timing of surgical drainage for pancreatic pseudocyst . Ann Surg . 1985;202:720-724.Crossref 10. Cremer M, Deviere J, Engelholm L. Endoscopic management of cysts and pseudocysts in chronic pancreatitis: long-term follow-up after 7 years of experience . Gastrointest Endosc . 1989;35:1-9.Crossref 11. Donnelly PK, Lavelle J, Carr-Locke D. Massive hemorrhage following endoscopic transgastric drainage of pancreatic pseudocysts . Br J Surg . 1990;77: 758-759.Crossref 12. Gadacz TR, Trunkey D, Kieffer RF. Visceral vessel erosion associated with pancreatitis . Arch Surg . 1978;113:1438-1440.Crossref 13. Bluett MK, Bean D, Powers TA, O'Leary JP. Combined computerized tomography and angiography in evaluation of hemorrhage into pancreatic pseudocysts . South Med J . 1987;80:253-255.Crossref 14. Eckhauser FE, Stanley JC, Zelenack GB, Borlaza GS, Freier DT, Lindenauer SM. Gastroduodenal and pancreaticoduodenal artery aneurysms: a complication of pancreatitis causing spontaneous gastrointestinal hemorrhage . Surgery . 1980; 88:335-344. 15. Stabile BE, Wilson SE, Debas HT. Reduced mortality from bleeding pseudocysts and pseudoaneurysms caused by pancreatitis . Arch Surg . 1983;118:45-51.Crossref 16. Bresler L, Boissel P. Grosdidier J. Major hemorrhage form pseudocysts and pseudoaneurysms caused by chronic pancreatitis: surgical therapy . World J Surg . 1991;15:649-653.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Mar 1, 1996

References