Pancreatitis after transcatheter embolization of a splenic aneurysm

Abstract

A 52-year-old woman was treated for a splenic aneurysm that was found on abdominal computed tomography (CT) during a preoperative assessment for rectal cancer. The aneurysm was embolized using the “double coil-delivered microcatheter technique,” and 4 ml of a mixture of N-butyl 2-cyanoacrylate (NBCA) and iodized oil (Lipiodol) (NBCA/Lipiodol = 1.0: 2.5) were injected into the aneurysm. The patient complained of left upper quadrant abdominal pain immediately after the procedure. A blood test 2 days after the procedure showed an increased white blood cell count (13 100/μl), C-reactive protein (13.36 mg/dl), and pancreatic amylase (428 U/l). Abdominal CT scan showed a huge cystic lesion at the pancreatic tail, in the center of which was a highly enhanced area due to accumulated NBCA-Lipiodol. Postembolization pancreatitis was diagnosed, and treatment with fasting and a drip infusion of nafamostat mesilate was started. The patient’s abdominal pain became less severe within 3 days, and the pancreatic enzyme level had normalized 14 days after treatment. On CT, the cystic lesion at the pancreatic tail was smaller 20 days after the procedure, and it had disappeared completely 75 days after the procedure.