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Z Gastroenterol 2015; 53(07): 664-667
DOI: 10.1055/s-0034-1399722
Kasuistik
© Georg Thieme Verlag KG Stuttgart · New York

Massive untere gastrointestinale Blutung nach Polypektomie durch Kolonfistel eines Pseudoaneurysmas der Arteria lienalis bei chronischer Pankreatitis

Massive lower gastrointestinal hemorrhage after polypectomy due to a colon fistula of a pseudoaneurysm of the splenic artery caused by chronic pancreatitis
C. Maegerlein
,
E. J. Rummeny
,
J. Gaa
Further Information

Publication History

19 February 2015

21 April 2015

Publication Date:
13 July 2015 (online)

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Zusammenfassung

Eine lebensbedrohliche, untere, gastrointestinale Massenblutung ist eine seltene Komplikation nach koloskopischer Polypektomie. Wir berichten über einen Patienten mit chronischer Pankreatitis und tryptischer Arrosion der Arteria lienalis mit Ausbildung eines großen Pseudoaneurysmas, welches fistelartigen Anschluss an das Colon descendens finden konnte. Es wurde eine lebensbedrohliche Massenblutung induziert, da die Situation im Rahmen einer Koloskopie mit Polypektomie nicht erkannt wurde und im Rahmen einer Schlingenabtragung eines villösen Polypen eine großflächige Kommunikation des Pseudoaneurysmas mit dem Colon descendens geschaffen wurde. Während die Blutung interventionell angiografisch primär beherrscht werden konnte, verstarb der Patient wenige Tage später im Multiorganversagen bei Verbrauchskoagulopathie.

Abstract

A life-threatening lower gastrointestinal bleeding is a rare complication due to coloscopic polypectomy. The following case report deals with a severe bleeding that was caused by polypectomy of a villous adenoma in a patient with chronic pancreatitis causing a huge pseudoaneurysm of the splenic artery. After polypectomy a wide iatrogenic communication between the pseudoaneurysm and the colon existed causing massive arterial intraluminal bleeding. Although this was successfully managed by transcatheter arterial embolization via splenic artery, the patient died a few days later caused by disseminated intravasal anticoagulation and multi organ failure.

Schlüsselwörter

Arrosionsblutung Arteria lienalis - chronische Pankreatitis - untere gastrointestinale Blutung - Pseudoaneurysma Arteria lienalis - transarterielle Embolisation - Polypektomie

Key words

arrosion haemorrhage of the splenic artery - chronic pancreatitis - lower gastrointestinal bleeding - pseudoaneurysm of the splenic artery - transarterial mmbolisation - polypectomy
 

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