Case 53

 A fifty two-year-old female was admitted to our hospital for taking rehabilitation. Approximately one month before admission, she had received emergent coil embolization of the right vertebral artery because of the dissected vertebral artery in an emergent hospital 30 minutes-drive-away from our hospital. After embolization, brain MRI with diffusion-weighted imaging showed small infarction of cerebellum and medulla oblongata. She was given cilostazole for approximately one month. She was unsteady in walking and remained sensory disturbance of left hemi-body. Then, she was introduced to our hospital. Nausea and vomiting occurred late at night on the following day (Day 1) . Day 2, vomiting continued each time after she ate meals. She received non-enhanced abdominal CT which showed suspicious hematoma in the pancreas uncus (Fig. 1), followed by contrast-enhanced CT which showed three sites of extravasation of contrast medium in the pancreas (Fig. 2). Laboratory tests revealed no evidence of abnormality.

What is the most appropriate management for pancreas bleeding ?

a. Embolization with gelatin sponge particles

b. Embolization with n-butyl cyanoacrylate

c. Embolization with microcoils

d. Surgical repair

1.a, b, c　　 2. b, c 　　 3. a, c 　　 4. d

answer

2017.5.10