International Surgery Journal | December 2021 | Vol 8 | Issue 12 Page 3745 International Surgery Journal Bakhshi G et al. Int Surg J. 2021 Dec;8(12):3745-3748 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Case Report Pancreatic pseudoaneurysm and its conundrum Girish Bakhshi 1 , Sushrut Baligar 1 *, Aishwarya Dutt 1 , Rajalakshmi Venkateswaran 1 , Avinash Gutte 2 , Ravi Landge 1 , Chettubattina Ravi Teja 1 INTRODUCTION A pancreatic pseudoaneurysm usually occurs when there is an erosion of a peripancreatic or pancreatic artery into a pseudocyst. 1 Increased excretion of elastase, induced by chronic local inflammation, leads to autodigestion of peripancreatic vessels or erosion of concomitant pseudocysts into adjacent vessels. 2 Though splenic artery pseudoaneurysm is the most common visceral artery pseudoaneurysm less than 200 cases have been described. 3 Pseudoaneurysm of pancreaticoduodenal and its branches are even rarer and less than 50 cases have been described in literature. CASE REPORT A 37 year old male patient presented with pain in abdomen and vomiting since 10-15 days. The pain in abdomen was periumbilical, insidious onset and gradually progressive and colicky in nature. The vomiting was non bilious, non-hemorrhagic and contained undigested food particles. The patient reported similar complaints 1 year back and was treated conservatively. He was a known alcoholic since 10-12 years and consumed approximately 10 units per week. On admission to the hospital he was hemodynamically stable. Abdominal examination revealed a non-tender epigastric lump of approximate size 10×6 cm was noted extending from epigastrium to just above the umbilicus. Ultrasound of the abdomen showed chronic calcific pancreatitis with 10×16×21 cm hypoechoic collection surrounding the pancreas extending superiorly till the right hypochondriac region and inferiorly till the pelvic region, features suggestive of pancreatic pseudocyst. During the course of stay in the hospital patient had an episode of haematemesis and fainting episode. The hemoglobin dropped from 9 g/dl to 6 g/dl in a span of 3 days. Resuscitation was done and blood transfusions were given. Emergency contrast enhanced computed tomography was done which showed thrombosed segment of gastroduodenal artery with pseudoaneurysm likely arising from superior pancreaticoduodenal artery, communication of subhepatic pseudocyst with first part of duodenum with hemorrhagic content within. The ABSTRACT Rupture of visceral artery pseudoaneurysm can lead to hypovolemic shock in a patient with pancreatitis. With the advent of minimally invasive treatment techniques most of these can be managed by minimally invasive route and have excellent prognosis when timely intervention is initiated. Herewith, we reported a case of ruptured pseudoaneurysm of superior pancreaticoduodenal artery in a patient with pancreatitis who presented with haematemesis. The patient was successfully managed with coil embolization. A brief case report with review of literature is presented here. Keywords: Pancreatitis, Pseudoaneurysm, Coil embolization, Haematemesis 1 Department of General Surgery, 2 Department of Radiology, Grant Government Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India Received: 04 October 2021 Accepted: 30 October 2021 *Correspondence: Sushrut Baligar, E-mail: baligarsushrut@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: https://dx.doi.org/10.18203/2349-2902.isj20214780