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Bleding From the Splenic Artery into a Pancreatic Pseudocyst with a Coexisting Microfistula to the Transverse Colon as Atypical Recurent Masive Gastrointestinal Bleding

100%

Fabiszewski A. , Jackowski M.

Polish Journal of Surgery

2009

tom 81

nr 11

542-549

Here we present a case of a 49-year old male patient who was hospitalized at our Clinic from 2 to 16 December 2008 due to recurrent massive gastrointestinal bleeding. It was a patient with a history of recurrent pancreatitis. He had a history of surgical treatment for postinflamamtory pancreatic cyst (Jurasz cystogastrostomy). From 28.01.2007 to 16.12.2008 he was hospitalized five times. During the last hospitalization he received a total of 12 units of packed red blood cells. Neither gastroscopy nor colonoscopy did demonstrate the site of bleeding. AngioCT of the abdominal cavity demonstrated clearly enlarged spleen and a well delineated region, 30×35 mm, reaching spleen hilum, filled with dense fluid suggesting a vascular fistula, in the projection of the body and tail of the pancreas. The patient was qualified for laparotomy. Intraoperatively, bleeding from the splenic artery into the pancreatic pseudocyst with coexisting microperforation to the transverse colon was detected. The pancreatic cyst was opened and drained, the bleeding blood vessel as well as the splenic artery were underpinned. Splenectomy was performed and wall of the transverse colon was repaired. The patient underwent reoperation due to adhesion related small bowel obstruction on day 30 after the procedure. Currently the patient is in good general condition, without complaints, undergoes periodic follow up in the outpatient setting.

Chances of using splenic artery as an accessory source of blood supply for kidneys

88%

Koziorowski A. , Porwolik K. , Kurlej W. , Porwolik M.

Folia Histochemica et Cytobiologica. Supplement

1996

tom 34

nr 1

The clinical relevance of coeliac trunk variations

75%

Gielecki J. , Zurada A. , Sonpal N. , Jablonska B.

Folia Morphologica

2005

tom 64

nr 3

123-129

The coeliac trunk is a surgically significant artery originating from the abdominal aorta and supplying the supracolic organs. Branches of this arterial trunk supply the primary organs of the abdomen and divert a significant volume of blood from the abdominal aorta. Past research has shown that the anatomy of the coeliac trunk is not identical for all human beings and that about 15% of the population displays significant variations from the typical branching pattern. Data derived from earlier research has been consolidated to give an account of the major variations found in the anatomy of the coeliac trunk and to put forward some theories for the cause of such variation. It is crucial to achieve full comprehension of these topics as knowledge of these variations is indispensable in operative and diagnostic procedures within the abdomen. Without understanding of the arterial architecture and knowledge of the variation characterising the patient in this critical region surgery may entail a considerable risk of an error being committed that may occasionally lead to lethal complications.