An-Najah Staff

INTRODUCTION: A bleeding pesudoaneurysm of peripancreatic artery can present with massive upper gastrointestinal hemorrhage. A history of pancreatitis and urgent imaging is crucial in making the diagnosis. Selective embolisation of the bleeding artery has gained much attention as first line of treatment. Here, we report a patient with alcoholic chronic pancreatitis presented with a ruptured pseudoaneurysm of gastroduodenal artery. He was successfully treated with percutaneous angiographic embolization.
CLINICAL PRESENTATION: This was a 54-year old Indian man who had a long history of daily alcohol intake. He had multiple admissions to the private hospitals for pancreatitis. One afternoon, he was rushed to hospital after experiencing sudden epigastric pain and hematemesis. Upper GI endoscopy could not detect the source of bleeding. Urgent CT scan reviewed a huge bleeding pseudoaneurysm of the gastroduodenal artery. Transcatheter arterial embolization was performed. Hemostasis was secured.
DISCUSSION: Pseudoaneurysms can bleed into the gastrointestinal tract, peritoneal cavity, retroperitoneum, biliopancreatic ducts or pseudocysts. Prompt localization of a pseudoaneurysm via imaging studies is critical. The reported success rate of embolization was 79-100% and the reported mortality rate after embolization was 12-33% in patients with acute or chronic pancreatitis.
CONCLUSION: Transcatheter selective arterial embolization is a highly effective treatment for acute bleeding from a ruptured pseudoaneurysm secondary to pancreatitis. However, early diagnosis and effective resuscitation is an essential prerequisite factor for urgent referral to center with interventional radiology.

The objective of this study was to examine and evaluate the frequency of bleeding and serious drug interactions among patients with atrial fibrillation (AF) treated with oral anticoagulant [Warfarin]. A random sample of 59 patients from Al-Watni government hospital in Nablus with a principal or secondary discharge diagnosis of AF was identified. All drug and clinical data were abstracted from the patient's files. We excluded patients who were less than 65 years of age, or left the hospital against medical advice, and those whose AF was transient or could not be confirmed. Of the original 59 AF patients, 19 were cliagnosed who were discharged on Warfarin. The mean age for these patients was 71.7 years. Among the patients discharged on Warfarin, 94.7 % had one or more drug – drug interactions that could lead to increase risk of bleeding. Many patients discharged on Warfarin were having multiple interacting drugs. Patient counseling and follow-up monitoring are essential and should be carried out to minimize the risk of bleeding and other complications.