A 37-year-old man with a 1-year history of intermittent abdominal pain was transferred to our hospital. Contrast-enhanced computed tomography (CT) revealed features of chronic pancreatitis, including diffuse pancreatic calcifications, dilation of the pancreatic duct, and a pancreatic pseudocyst (PPC). Additionally, a splenic artery pseudoaneurysm (PsA) was identified inside the pseudocyst ( Fig. 1 ).
Fig. 1.
Contrast-enhanced computed tomography images showing: a Pancreatic pseudocyst; b A splenic artery pseudoaneurysm inside the pseudocyst.
Endoscopic ultrasound (EUS) revealed a well-defined PsA, measuring 1.3 cm × 1.2 cm, arising from the splenic artery and located within a PPC. Doppler imaging demonstrated active arterial flow with a characteristic “to-and-fro” waveform ( Fig. 2 ). The PPC measured approximately 5 cm in diameter and was situated posterior to the gastric fundus. We first punctured into the PPC using a 19-G biopsy needle and aspirated 50 mL of dark brown fluid ( Fig. 3 ). Subsequently, the needle was exchanged for a 22-G biopsy needle (G31521, Cook Medical, USA), through this access, a 10 mm × 10 mm Tornado embolization microcoil was deployed, followed by injection of a mixture consisting of 1 mL cyanoacrylate glue and 1 ml distilled water, achieving complete PsA occlusion ( Fig. 4 , Video 1 ). Subsequently, the 19-G biopsy needle was reinserted to place a guidewire. Then, the gastric and cyst walls were incised with a cystotome (CST-10, Cook Medical, Ireland), and a 7-Fr double-pigtail nasocystic drainage catheter (PBD-V813W-07, Olympus, Japan) was positioned for continuous drainage.
Fig. 2.
The PPC measured approximately 5 cm in diameter. Endoscopic ultrasound images showing a 1.3 cm × 1.2 cm splenic artery pseudoaneurysm from the splenic artery with a characteristic “to-and-fro” waveform on Doppler.
Fig. 3.
a Puncture into the pancreatic pseudocyst using a 19-G biopsy needle; b Aspirate 50 mL of dark brown fluid.
Fig. 4.
EUS-guided treatment of a splenic artery pseudoaneurysm: a A splenic artery pseudoaneurysm; b Replace with a 22-G biopsy needle; c Injection of cyanoacrylate glue into the pseudoaneurysm; d Complete embolization of the pseudoaneurysm.
EUS-guided treatment of splenic artery pseudoaneurysm and pancreatic pseudocyst.
Video 1
The X-ray shows the drainage catheter is in the normal position. During postoperative follow-up, CT imaging demonstrated proper positioning of the coils within the PsA, without evidence of splenic infarction ( Fig. 5 ).
Fig. 5.
a Double-pigtail nasocystic drainage catheter in the correct position; b Computed tomography imaging demonstrated proper positioning of the coils within the PsA, without evidence of splenic infarction.
PPC and PsA are common complications of pancreatitis 1 . PsA is associated with a rupture risk of up to 40%. Upon rupture, it may lead to life-threatening hemorrhage, with mortality rates reaching as high as 90% 2 . This case provides a more effective and efficient treatment option for patients with concomitant PPC and PsA.
Endoscopy_UCTN_Code_TTT_1AS_2AD
Footnotes
Conflict of Interest The authors declare that they have no conflict of interest.
Contributorsʼ Statement Fengxin Wang: Data curation, Formal analysis, Methodology, Visualization, Writing – original draft. Baobao Wang: Data curation, Formal analysis, Methodology, Visualization, Writing – original draft. Zhenjun Wang: Data curation, Project administration, Writing – original draft, Writing – review & editing. Guan-Jun Kou: Data curation, Project administration, Writing – original draft, Writing – review & editing. Ning Zhong: Project administration, Resources, Writing – review & editing.
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E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos .
References
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