Case Report: Fatal recurrent rupture of multiple pancreatic pseudoaneurysms following acute alcoholic pancreatitis.
- 1Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China.
Abstract
Background
Pancreatic pseudoaneurysm (PPA) is a severe and life-threatening vascular complication of pancreatitis. This case highlights the critical need for comprehensive vascular assessment and surveillance in patients with alcoholic pancreatitis to prevent fatal adverse outcomes.Case presentation
A 53-year-old man with a 30-year history of heavy alcohol intake (500 mL of 52% ABV Baijiu daily, corresponding to an estimated 205 g pure ethanol per day) presented to our emergency department with hematemesis and hemorrhagic shock on 2 April 2026. He was diagnosed with acute pancreatitis complicated by a pancreatic pseudocyst at another hospital in November 2025 but did not receive standardized follow-up and treatment. Contrast-enhanced CT confirmed rupture of a pancreatic head pseudoaneurysm with hemorrhage extending into the duodenum. Emergency transarterial embolization of the gastroduodenal artery was performed, and hematemesis resolved temporarily. Subsequently, the patient developed progressive abdominal pain, distension, and peritoneal irritation signs. Repeat CT confirmed recurrent intra-abdominal hemorrhage. A second digital subtraction angiography (DSA) identified an unrecognized feeding branch arising from the superior mesenteric artery (SMA) supplying the pancreatic head pseudoaneurysm, which was successfully embolized. The patient's condition stabilized temporarily, with a gradual increase in hemoglobin levels. On 14 April 2026, the patient suffered sudden severe abdominal pain and abdominal distension. Follow-up contrast-enhanced CT revealed enlargement and rupture of a pre-existing tiny pseudoaneurysm in the splenic hilum, resulting in massive intra-abdominal hemorrhage. The patient developed refractory hemorrhagic shock followed by cardiac arrest during preparation for emergency endovascular intervention and ultimately died. Post-embolization hemodynamic changes may have contributed to progressive enlargement and subsequent rupture of the pre-existing lesion, although this causal mechanism cannot be definitively proven in this single case.Conclusion
This case illustrates that pancreatitis-associated pseudoaneurysms may be multifocal. Successful control of a dominant bleeding lesion does not eliminate the risk of rupture of the separate pre-existing small pseudoaneurysm, and incomplete initial angiography limited only to the celiac trunk may miss SMA feeding branches, even after technically successful initial endovascular intervention for pancreatitis-associated pseudoaneurysm.
Related
- Intrahepatic and Intrasplenic Pancreatic Pseudocysts Following Acute Pancreatitis: A Case Report
- Spontaneous fistulization of a giant pancreatic pseudocyst into the duodenum following acute pancreatitis: a case report
- Imaging evolution of pancreatic intraductal oncocytic papillary neoplasm presenting with recurrent pancreatitis: A case report and literature review.
- Spontaneous Bilateral Vesical Artery Pseudoaneurysms Presenting With Massive Recurrent Hematuria and Obstructive Acute Kidney Injury: A Case Report
- Endoscopic management of pancreatic duct stones and stricture in chronic pancreatitis using a fully covered self-expandable metal stent.
BibTeX
@article{wang2026case,
title = {{Case Report: Fatal recurrent rupture of multiple pancreatic pseudoaneurysms following acute alcoholic pancreatitis.}},
author = {Xin Wang and Deyu Zhang and Dongyang Wang and Hao Lin and Wenxiu Zhang and Xingshun Qi},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1948368},
url = {https://europepmc.org/article/MED/42923695},
note = {CC BY},
}
RIS
TY - JOUR
TI - Case Report: Fatal recurrent rupture of multiple pancreatic pseudoaneurysms following acute alcoholic pancreatitis.
AU - Xin Wang
AU - Deyu Zhang
AU - Dongyang Wang
AU - Hao Lin
AU - Wenxiu Zhang
AU - Xingshun Qi
PY - 2026
DA - 2026/10/08
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1948368
UR - https://europepmc.org/article/MED/42923695
AB - Background Pancreatic pseudoaneurysm (PPA) is a severe and life-threatening vascular complication of pancreatitis. This case highlights the critical need for comprehensive vascular assessment and surveillance in patients with alcoholic pancreatitis to prevent fatal adverse outcomes.Case presentation A 53-year-old man with a 30-year history of heavy alcohol intake (500 mL of 52% ABV Baijiu daily, corresponding to an estimated 205 g pure ethanol per day) presented to our emergency department with hematemesis and hemorrhagic shock on 2 April 2026. He was diagnosed with acute pancreatitis complicated by a pancreatic pseudocyst at another hospital in November 2025 but did not receive standardized follow-up and treatment. Contrast-enhanced CT confirmed rupture of a pancreatic head pseudoaneurysm with hemorrhage extending into the duodenum. Emergency transarterial embolization of the gastroduodenal artery was performed, and hematemesis resolved temporarily. Subsequently, the patient developed progressive abdominal pain, distension, and peritoneal irritation signs. Repeat CT confirmed recurrent intra-abdominal hemorrhage. A second digital subtraction angiography (DSA) identified an unrecognized feeding branch arising from the superior mesenteric artery (SMA) supplying the pancreatic head pseudoaneurysm, which was successfully embolized. The patient's condition stabilized temporarily, with a gradual increase in hemoglobin levels. On 14 April 2026, the patient suffered sudden severe abdominal pain and abdominal distension. Follow-up contrast-enhanced CT revealed enlargement and rupture of a pre-existing tiny pseudoaneurysm in the splenic hilum, resulting in massive intra-abdominal hemorrhage. The patient developed refractory hemorrhagic shock followed by cardiac arrest during preparation for emergency endovascular intervention and ultimately died. Post-embolization hemodynamic changes may have contributed to progressive enlargement and subsequent rupture of the pre-existing lesion, although this causal mechanism cannot be definitively proven in this single case.Conclusion This case illustrates that pancreatitis-associated pseudoaneurysms may be multifocal. Successful control of a dominant bleeding lesion does not eliminate the risk of rupture of the separate pre-existing small pseudoaneurysm, and incomplete initial angiography limited only to the celiac trunk may miss SMA feeding branches, even after technically successful initial endovascular intervention for pancreatitis-associated pseudoaneurysm.
SN - 2296-858X
ER -