Objectives Gastrointestinal visceral artery pseudoaneurysms are rare. This study was carried out in a tertiary health care center in Mumbai to study the patients with gastrointestinal visceral artery pseudoaneurysms due to chronic pancreatitis presenting as gastrointestinal bleed. Methods Patients with chronic pancreatitis presenting with gastrointestinal bleeding due to visceral artery pseudoaneurysms were studied in this prospective study for a period of two years from August 2013 to July 2015. Patients’ demographic data, symptoms at presentation, risk factors, comorbid conditions, laboratory investigations, imaging characteristics were studied. The patients underwent interventions either radiological or surgical. All patients were followed up for three months post-procedure. Results The incidence of pseudoaneurysms in chronic pancreatitis was 7.7%. Twelve patients with chronic pancreatitis had gastrointestinal visceral artery pseudoaneurysms who presented as gastrointestinal bleed. Splenic artery was the most common artery involved (six of twelve patients), followed by gastroduodenal artery (four patients), right gastroepiploic artery (two patients) and short gastric artery (one patient). The size of pseudoaneurysm ranged from 6 mm to 6.3 cm. All patients underwent interventions; transcatheter embolization of pseudoaneurysms in 11 patients and surgical management in the form of splenectomy in one patient. All patients tolerated radiological interventions well without major complications and did not have recurrent bleeding in three months of follow up. Conclusions Pseudoaneurysms of gastrointestinal visceral arteries due to chronic pancreatitis are rare and need prompt intervention either surgical or endovascular. Endovascular therapy in the form of transcatheter embolization is effective in achieving hemostasis. More prospective studies are needed to compare endovascular therapy versus surgical therapy as the treatment modality of gastrointestinal visceral artery pseudoaneurysms.
Dattatray Solanke, Chetan Rathi, Nirav Pipaliya, Prateik Poddar, Vikas Pandey, Meghraj Ingle, Prabha Sawant