Editor's quiz: GI snapshot
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From question on page 10.1136/gut.2006.103804
The common bile duct and intrahepatic bile ducts were dilated (fig 1). The mass seen is a pseudoaneurysm of the gastroduodenal artery. The associated haematoma was compressing the common bile duct, causing obstructive jaundice. There was no free extravasation of contrast and a decision was made to treat this with selective arterial embolisation.
Pseudoaneuryms complicate pancreatitis in up to 10%, due to vessel wall degeneration secondary to enzymatic autodigestion, particularly affecting the splenic and gastroduodenal arteries.
Diagnosis can be confidently made on multiphasic CT which shows a focal, contained area of high density as the same attenuation as a main vessel. This is well defined (cf. contrast extravasation) and is often surrounded by accruing haematoma. Angiography is then undertaken with a view to selective embolisation and is now commonly the first line treatment. It has a reported success rate of 67–100%. Care must be taken
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Gut 2008 57: 180.[Extract] [Full Text] [PDF]
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