Hemorrhage as a complication of chronic pancreatitis
Jan Kancnýř1, Petr Kovala1, Milan Kremer1
1 Interna, Městská nemocnice Ostrava, p. o.
Hemorrhage due to chronic pancreatitis is an unusual complication, which can be life threatening, depending on its localization and intensity. Early diagnosis and hemorrhage localization are very important. Choice of the appropriate intervention depends on the actual hemodynamic condition and technical feasibility. This case report describes a patient with a long term history of chronic pancreatitis, complicated by a pancreatic head pseudocyst. The patient came to the hospital because of acute abdominal pain. During the examination, enlargement of the pseudocyst was detected, which was accompanied by oppression of the extrahepatic biliary duct. An intrapseudocyst hemorrhage was suspected. After CT revealed leakage of the contrast agent into the pseudocyst lumen, angiography was employed, which demonstrated coiling of a broken artery. After this, endoscopic retrograde cholangiopancreatography with biliary stent insertion to the d. choledochus was performed. During application of the contrast agent to the biliary ducts, the pseudocysts lumen was filled with the contrast agent, making transpapillary drainage possible using a mono pigtail. Complete regression of the pancreatic pseudocyst and spontaneous elimination of the mono pigtail were observed during a subsequent examination.
Keywordsangiography, chronic pancreatitis, haemorrhage, pancreatic pseudocyst
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