Fig. 2. Bleeding complications and interventional management. (A) A contrast-enhanced computed tomography (CT) scan demonstrates the heterogeneous and hyperdense content indicating a hematoma in the pseudocyst and distended stomach without evidence of contrast extravasation or pseudoaneurysm. Geographic hyperdense areas in the spleen suggest splenic ischemia. Note the cystogastrostomy stent in place. (B) Celiac angiography delineates a small pseudoaneurysm (arrow) at the origin of one short gastric artery from the splenic artery. (C) Selective angiography of the culprit, short gastric artery demonstrates contrast extravasation (asterisk) into the pseudocyst. Embolization using n-butyl-2 cyanoacrylate (NBCA) was performed (not shown) (D) Post-embolization angiography shows complete disappearance of the pseudoaneurysm. (E) Follow-up gastroduodenoscopy performed two days after the embolization shows the cystogastrostomy stent in place and no evidence of bleeding. (F) Follow-up CT obtained after one month shows the cystogastrostomy stent (arrow) in place and the decreased size of the NBCA-filled pancreatic pseudocyst (arrowhead).
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