A case of chronic pancreatitis with celiac axis stenosis complicated by hepatic artery pseudoaneurysm: a therapeutic challenge.

BACKGROUND: While hepatic artery pseudoaneurysm is an uncommon complication of the chronic pancreatitis, celiac axis stenosis has rarely been reported in chronic pancreatitis. Although both of these entities have been reported in isolation, simultaneous occurrence of these two problems in one patient of chronic pancreatitis has not been reported so far.

METHODS: A 32-year-old nonalcoholic male presented with hematemesis and melena for one month. He had undergone longitudinal pancreatico-jejunostomy for the idiopathic chronic pancreatitis one year back. Esophagogastroduodenoscopy could not find any source, but CT angiography revealed a 1.5 × 1.5 cm common hepatic artery pseudoaneurysm along with the complete stenosis of the celiac axis.

RESULTS: As the endovascular approach was not found to be feasible, surgical ligation of the pseudoaneurysm was performed. Intraoperatively, peripancreatic adhesions with multiple arterial collaterals were found. Patient had an uneventful postoperative recovery, and has been well during the last six months of follow up with no recurrence of bleeding.

CONCLUSIONS: As the presence of celiac axis stenosis may alter the management plan of bleeding visceral artery pseudoaneurysm, this abnormality should always be looked for in CT angiography performed for suspected bleeding visceral artery pseudoaneurysm.