Chronic Abdominal Pain

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Chronic abdominal pain . Male in 60’s . History of alcohol use . Presently admitted with acute abdominal pain, hematemesis and drop in Hb CT Abdomen and pelvis with IV contrast . Study from 1 month prior to admission . What is the diagnosis? CT Abdomen and pelvis with IV contrast . What is the diagnosis? Features suggestive of chronic pancreatitis Present admission . CT Abdomen and pelvis with IV contrast requested . Contrast infiltration in the arm leading to a non contrast study . What are the findings? . What is the differential? Present admission . Non Contrast CT Abdomen and pelvis . What are the findings? High attenuation material in the cystic areas . What is the differential? Hematoma or active bleeding Repeat CT with contrast . Only relevant images displayed . What are the findings? . What other images would you need to review? Repeat CT with contrast . What are the findings? Pseudoaneurysms along the GDA . What other images would you need to review? Multiplanar reformatted images Volumetric and MIP image . Any additional information from this image? Volumetric and MIP image . Any additional information from this image? Pseudoaneurysms along the GDA What branch of GDA does the PSA arise from? Angiogram . Based on the prior images, angiogram was requested? . What vessel is catheterized? . Any abnormality? . What to do next? Angiogram . What vessel is catheterized? Celiac artery . Any abnormality? Pseudoaneurysms . What to do next? Embolization Angiogram . When the abnormality is not visualized in one view, different projections are needed for better assessment and planning Angiogram . What branch of GDA does the PSA arise from? Supraduodenal artery Take Home Points . Reported incidence of arterial complications in pancreatitis is 4% to 10%1 . Being minimally invasive, safer and effective, embolization is the preferred choice in majority of the presentations. Supraduodenal arteries: . In its most common configuration, the GDA first gives rise to one or more supraduodenal arteries of Wilkie, within 3 mm of its origin2 . Can also arise from RGA in 13% of cases, as well as from posterior superior pancreaticoduodenal artery (PSPDA) occasionally3,4 1. Sethi H, Peddu P, Prachalias A, et al. Selective embolization for bleeding visceral artery pseudoaneurysms in patients with pancreatitis. Hepatobiliary Pancreatic Dis Int 2010; 9: 634-8. 2.Skandalakis JE, Skandalakis LJ, Colborn GL, Pemberton LB, Gray SW. The duodenum. Part 2: Surgical anatomy. Am Surg. 1989;55:291–8 3.Vandamme J, Bonte J. The blood supply of the stomach. Cells Tissues Organs. 1988;131:89–96. 4.Wilkie D. The blood supply of the duodenum with special reference to the supraduodenal artery. Surg Gynecol Obstet. 1911;13:399–406. .

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