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Splenic artery pseudoaneurysm and resultant haematosuccus pancreaticus
  1. Shwetambari Sonanis1,
  2. Benjamin Layton2,
  3. Oliver Nicholson1 and
  4. DA Subar3
  1. 1HPB surgery, Royal Blackburn Hospital, Blackburn, Lancashire, UK
  2. 2Radiology, East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UK
  3. 3HPB Surgery, Royal Blackburn Hospital, Blackburn, Lancashire, UK
  1. Correspondence to Dr Benjamin Layton; Benjamin.Layton{at}ELHT.NHS.UK

Abstract

Splenic artery pseudoaneurysm (SAP) is a rare and dangerous diagnosis with a high risk of rupture and death. It is the most common cause of main pancreatic duct haematoma—haematosuccus pancreaticus (HP). Neither SAP nor HP have specific clinical features that allow diagnosis without cross-sectional imaging. Upper gastrointestinal haemorrhage and a history of pancreatitis should raise clinical suspicion but ultimately endoscopy and CT are required. We report a case of a 51-year-old man without clinical symptoms in whom cross-sectional imaging was undertaken for incidental severe acute anaemia. This demonstrated stigmata of chronic pancreatitis and the main pancreatic duct was distended with dense material in keeping with haematoma. The diagnosis of a SAP bleeding into the main pancreatic duct was made radiologically. A subsequent oesophago-gastro-duodenoscopy confirmed the diagnosis. The imaging appearances, pathophysiology and management are discussed.

  • general surgery
  • radiology
  • gastrointestinal system
  • GI bleeding

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Footnotes

  • Contributors SS, BL, ON and DAS have met this following criteria to become authors for this case study: Substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. Drafting the work or revising it critically for important intellectual content. Final approval of the version published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.