Dr. Keyur Bhatt - Gastrosurgeon

Dr. Keyur Bhatt - Best Gastro Surgeon

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Dr. Keyur Bhatt - Best Gastro Surgeon

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Dr Keyur Bhatt- Best GI Surgeon

CASE: MINIMAL INVASIVE PANCREATIC NECROSAECTOMY^-www.drkeyurbhatt.in*

28 yrs male with severe nerotizing pancreatitis
with sepsis. on 28 days of illness

CECT:

SURGERY:
Lap assisted minimal invasive pancreatic necrosectomy:

pt discharged on POD 7 with drain in situ..

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Dr Keyur Bhatt- Best GI Surgeon

CASE: LAPAROSCOPIC TRANS PERITONEAL NECROSECTOMY^-www.drkeyurbhatt.in*

Middle aged male with acute necrotizing pancreatitis (Alcoholic). with persistent fever and nausea.
26 kg of wt loss. and on and off abdominal pain. 2 months following acute attack of necrotizing pancreatitis.

CECT:

SURGERY: TOTAL Laparoscopic Trans peritoneal necrosectomy, lavage and drainage.

opening of lesser sac

stomach lifted and lesser sac entered at the area of necrosis

removal of necrosis

placement of drain

post op

dirty necrotic material

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Tuesday, July 5, 2011

CASE : SPLENIC ARTERY PSEUDOANURISM BLEEDING Status TWICE COILING Status Chronic pancreatitis (alcoholic)^-www.drkeyurbhatt.in*

after 9 months of follow up Pt is doing well and gained 8 kg wt....no further complaints...

previous angio coiling, patent pancreatica
megna branch and partially occluded splenic artery

ligation of splenic artery at its origin before
arteria pancreatic magna branch

pseudoanurism in arteria pancreatica
magna teritory

Pancreatic Pseudoaneurysm: Treatment

Transarterial catheter angioembolization with or without endoscopic stent placement.

o Endovascular coil embolization has been used extensively in the treatment of visceral artery pseudoaneurysms.

o Angioembolization is considered much less invasive than surgery. The procedure can be completed quickly and is comfortable for the patient. It also allows the performance of surgery under optimal conditions.

o The interventional approach has a reported success rate of 67-100% over the past few years.⁶

o Most authorities agree that embolization is appropriate when bleeding is diffuse or emanating from the pancreatic head, for unsuccessful surgery, or during postoperative bleeding.

o Failure results from an inability to selectively catheterize the bleeding vessel or the misplacement or poor placement of embolization material.

o In addition to rebleeding, complications of this procedure include rupture of the pseudoaneurysm during embolization, arterial perforation by the catheter, intestinal necrosis, and aortic thrombosis.

SURGICAL TREATMENT

The indications for emergent exploratory laparotomy include hemodynamic instability and failure of endovascular techniques to control active hemorrhage.

Basic surgical techniques for controlling hemorrhage from a pancreatic pseudoaneurysm include arterial ligation on both sides of the bleeding sites, pancreatic resection, and intracystic/extracystic multiple ligatures

Clinical features and management of splenic artery

pseudoaneurysm: Case series and cumulative

review of literature

(J Vasc Surg 2003;38:969-74.)

Deron J. Tessier, MD,a William M. Stone, MD,a Richard J. Fowl, MD,a Maher A. Abbas, MD,a James C.

Andrews, MD,b Thomas C. Bower, MD,c and Peter Gloviczki, MD,c Scottsdale, Ariz; and Rochester, Minn

Introduction: Splenic artery pseudoaneurysm is uncommon. We report our institution’s recent 18-year experience with

these aneurysms and review the literature.

Methods: We reviewed the records for 37 patients with visceral artery pseudoaneurysm evaluated at our institution from

1980 to 1998. From this group we found only 10 patients (27%) with splenic artery pseudoaneurysm. We also reviewed

147 cases of splenic artery pseudoaneurysm reported in the English literature.

Results: In this series of 10 patients, 5 were men. Mean age was 51.2 years (range, 35-78 years). Causes of aneurysm

included chronic pancreatitis in 4 patients, trauma in 2 patients, iatrogenic cause in 1 patient, and unknown cause in 3.

The most common symptom was bleeding in 7 patients and abdominal or flank pain in 5 patients; 2 patients had no

symptoms. Aneurysm diameter was known for four pseudoaneurysms, and ranged from 0.3 to 3 cm (mean, 1.7 cm).

Splenectomy and distal pancreatectomy were performed in 4 patients, splenectomy alone in 2 patients, endovascular

transcatheter embolization in 2 patients, and simple ligation in 1 patient. One patient with a ruptured pseudoaneurysm

died before any intervention could be performed; there were no postoperative deaths. Follow-up data were available for 7 patients, with a mean of 46.3 months (range, 4.5-120 months).

Conclusions: Splenic artery pseudoaneurysm is rare and usually is a complication of pancreatitis or trauma. Average aneurysm diameter in our series of 10 patients was smaller than previously reported (1.7 cm vs 5.0 cm). Although conservative management has produced excellent results in some reports, from our experience and the literature, we recommend repair of all splenic artery pseudoaneurysms.

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