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Gastroenterology - Pancreatology
A 71-year-old man presented with severe abdominal pain and jaundice. Multimodal imaging demonstrated necrotizing pancreatitis secondary to choledocholithiasis, complicated by acute peripancreatic collections and nonocclusive left portal vein thrombosis. Therapeutic anticoagulation with low-molecular-weight heparin was commenced. Six days later, he developed large-volume frank rectal bleeding with hemorrhagic shock, requiring massive blood transfusion and vasopressor support. Computed tomographic angiography demonstrated a pseudoaneurysm arising from a distal branch of the splenic artery, with surrounding hematoma and active contrast extravasation at the splenic flexure into the descending colon. Digital subtraction angiography subsequently confirmed a pseudoaneurysm arising from a distal pancreatic branch with a communicating omental branch.
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