Clinical case
Drug-Induced Acute Pancreatitis and Pseudoaneurysms: An Ominous Combination
Pancreatite Aguda Medicamentosa e Pseudoaneurismas: Uma Combinação Tenebrosa
Diogo Branquinho, , Daniel Ramos-Andrade, Luís Elvas, Pedro Amaro, Manuela Ferreira, Carlos Sofia
Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
Received 15 March 2016, Accepted 06 June 2016
Abstract

Rupture of pseudoaneurysms is rare but can be life-threatening complications of acute or chronic pancreatitis, usually due to enzymatic digestion of vessel walls crossing peripancreatic fluid collections. We report the case of a 40 year-old female, with multisystemic lupus and anticoagulated for prior thrombotic events, admitted for probable cyclosporine-induced acute pancreatitis. Hemodynamic instability occurred due to abdominal hemorrhage from two pseudoaneurysms inside an acute peri-pancreatic collection. Selective angiography successfully embolized the gastroduodenal and pancreatoduodenal arteries. The hemorrhage recurred two weeks later and another successful embolization was performed and the patient remains well to date. The decision to restart anticoagulants and to suspend cyclosporine was challenging and required a multidisciplinary approach. Despite rare, bleeding from a pseudoaneurysm should be considered when facing a patient with pancreatitis and sudden signs of hemodynamic instability.

Resumo

Os pseudoaneurismas são complicações raras mas graves da pancreatite aguda ou crónica. São causados pela digestão enzimática de artérias que atravessam colecções inflamatórias. Descreve-se o caso de uma doente do sexo feminino, de 40 anos, com lúpus sistémico e anticoagulada por trombose venosa profunda, admitida por pancreatite aguda associada à ciclosporina. Apresentou sinais de hemorragia abdominal causada por dois pseudoaneurismas dentro de uma colecção peri-pancreática. Foi então realizada angiografia com embolização da artéria gastroduodenal e pancreatoduodenal. Houve recidiva duas semanas depois, com necessidade de nova embolização bem-sucedida. A decisão de suspender a ciclosporina e reintroduzir anticoagulantes nesta doente de alto-risco é controversa. Apesar de raros, os pseudoaneurismas devem ser considerados perante um doente com pancreatite e sinais de hemorragia.

Keywords
Aneurysm, False, Embolization, Therapeutic, Pancreatitis/chemically induced
Palavras-chave
Falso Aneurisma, Embolização Terapêutica, Pancreatite/induzida quimicamente

Open Access

Creative Commons License
GE - Portuguese Journal of Gastroenterology is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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