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Combined Surgical Management of Ruptured Splenic Artery Pseudoaneurysm with Pancraetic-Duct Stricture in Complex Polytrauma Patient

Monika Gupta

Objective Pancreatic stricture in trauma or chronic pancreatitis leads to increased intraductal pressure and localised leak of pancreatic juices which causes pseudoaneurysm of splenic artery or other adjacent arteries. Simultaneous surgery for ruptured splenic artery pseudoaneurysm and drainage procedure for pancreatic duct stricture is not reported in literature. Attempts to classify peripancreatic pseudoaneurysm based on whether communication with pancreatic duct presents or absent, have been useful in selection of management strategy of this patient. Although embolization is first step in management of pseudoaneurysm but in a patient with dual pathology only splenic artery embolization alone is not a sufficient measure to cure. In such case the causative factor pancreatic duct stricture may lead to recurrence of bleed by similar mechanisms. Case report We hereby report lifesaving surgery done in a complex polytrauma patient for posttraumatic pancreatic duct stricture and ruptured splenic artery pseudoaneurysm - Excision of pseudoaneurysm with ligation of splenic artery with splenectomy and lateral pancreatico-jejunostomy were done in same operation. Postoperatively patient had uneventful course and remained symptom free for last 2.5 years of f/up. In past this patient underwent 4 surgeries after pancreatic trauma - laparotomy and necrosectomy for posttraumatic periancreatic necrosis (done outside), laparotomy and drainage with ileostomy, ileostomy closure (authors unit), arthroscopic fixation of cruciate ligaments of left knee joint. Conclusion Pancreatic duct strictures can lead to splenic artery pseudoanurysm. In a hemodynamically stable, well evaluated patient, where localised pseudoaneurysm rupture is present along with pancreatic duct stricture, simultaneous surgery for pancreatic-duct drainage and pseudoaneurysm ligation can be safely done.