Báo cáo lâm sàng: can thiệp nội mạch cấp cứu điều trị võ giả phình động mạch lách có tình trạng sốc mất máu - một biến chứng ở bệnh nhân viêm tụy cấp

Splenic artery pseudoaneurysm rupture with hemorrhagic shockas complication of acute pancreatitis treated with emergency endovascular interventions: A case report

SUMMARY

Background: Rupture of splenic artery pseudoaneurysm (SAPs)secondary to pancreatitis is a uncommon complication, but one with a high mortality rate. Patient generally presented with gastrointestinal bleeding’s symptoms ranging from mild anemia to hemorrhagic shock.Contrast-enhanced abdominal computed tomography (CT) plays an important role in diagnosis, but digital subtraction angiography (DSA) is the gold-standard method to determine the correct diagnosis and make treatment planning. Nowadays, SAPs have been managed with many methods. Endovascular intervention remains the first choice asminimal invasion and a waste of the short time,especially for emergency cases. This article describes a case of SAPs rupture complicated by chronic pancreatitis. Patient admidtted with hypovolemic shock andsuccessfully treated using endovascular coil embolization.

Case presentation: A 46 years old man with a past medical histoty of pancreatitisattended to Bach Mai hospital due to hemorrhagic shock as result of acute upper gastrointestinal bleeding. He was intubated and received platelet infusion in secondary hospital.Upper gastrointestinal endoscopyshowed bleeding from the major duodenal papilla, but the source of bleeding remained obscured. CTrevealedrupture of splenic artery pseudoaneurysm causing haemosuccuspancreaticus and duodenal bleeding. Patient immediately managed with coil embolizationby Sandwich technique.After procedure, anemia was controlled steady, butsigns of peritonitis began to appear. At that time, CT images discovered multiple abcesses in hypogastric region and alsso suspectednecrosis of the colonic wall. The patient underwentcolectomy and colostomy in left lumbar region. On the 20th day, he was discharged from hospital with no symptoms and normal blood test.

Conclusion: Treatment of acute gastrointestinal bleeding from a splenic artery pseudoaneurysm rupture need to access rapidly and manage reasonably. Emergency endovascular interventions should be the first selection to prevent continous bleeding.

Keyword: splenic artery aneurysm rupture, hemorrhagic shock, pancreatitis, emergency endovascular interventions.