Endoscopic ultrasound-guided treatment of splenic artery pseudoaneurysm and pancreatic pseudocyst

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A 37-year-old man with a 1-year history of intermittent abdominal pain was transferred to our hospital. Contrast-enhanced computed tomography (CT) revealed features of chronic pancreatitis, including diffuse pancreatic calcifications, dilation of the pancreatic duct, and a pancreatic pseudocyst (PPC). Additionally, a splenic artery pseudoaneurysm (PsA) was identified inside the pseudocyst ([ Fig. 1 ]). Fig. 1 Contrast-enhanced computed tomography images showing: a Pancreatic pseudocyst; b A splenic artery pseudoaneurysm inside the pseudocyst. Endoscopic ultrasound (EUS) revealed a well-defined PsA, measuring 1.3 cm × 1.2 cm, arising from the splenic artery and located within a PPC. Doppler imaging demonstrated active arterial flow with a characteristic “to-and-fro” waveform ([ Fig. 2 ]). The PPC measured approximately 5 cm in diameter and was situated posterior to the gastric fundus. We first punctured into the PPC using a 19-G biopsy needle and aspirated 50 mL of dark brown fluid ([ Fig. 3 ]). Subsequently, the needle was exchanged for a 22-G biopsy needle (G31521, Cook Medical, USA), through this access, a 10 mm × 10 mm Tornado embolization microcoil was deployed, followed by injection of a mixture consisting of 1 mL cyanoacrylate glue and 1 ml distilled water, achieving complete PsA occlusion ([ Fig. 4 ], [ Video 1 ]). Subsequently, the 19-G biopsy needle was reinserted to place a guidewire. Then, the gastric and cyst walls were incised with a cystotome (CST-10, Cook Medical, Ireland), and a 7-Fr double-pigtail nasocystic drainage catheter (PBD-V813W-07, Olympus, Japan) was positioned for continuous drainage. Fig. 2 The PPC measured approximately 5 cm in diameter. Endoscopic ultrasound images showing a 1.3 cm × 1.2 cm splenic artery pseudoaneurysm from the splenic artery with a characteristic “to-and-fro” waveform on Doppler. Fig. 3 a Puncture into the pancreatic pseudocyst using a 19-G biopsy needle; b Aspirate 50 mL of dark brown fluid. Fig. 4 EUS-guided treatment of a splenic artery pseudoaneurysm: a A splenic artery pseudoaneurysm; b Replace with a 22-G biopsy needle; c Injection of cyanoacrylate glue into the pseudoaneurysm; d Complete embolization of the pseudoaneurysm. Download Video EUS-guided treatment of splenic artery pseudoaneurysm and pancreatic pseudocyst.Video 1 The X-ray shows the drainage catheter is in the normal position. During postoperative follow-up, CT imaging demonstrated proper positioning of the coils within the PsA, without evidence of splenic infarction ([ Fig. 5 ]). Fig. 5 a Double-pigtail nasocystic drainage catheter in the correct position; b Computed tomography imaging demonstrated proper positioning of the coils within the PsA, without evidence of splenic infarction. PPC and PsA are common complications of pancreatitis [ 1 ]. PsA is associated with a rupture risk of up to 40%. Upon rupture, it may lead to life-threatening hemorrhage, with mortality rates reaching as high as 90% [ 2 ]. This case provides a more effective and efficient treatment option for patients with concomitant PPC and PsA. Endoscopy_UCTN_Code_TTT_1AS_2AD Endoscopy E-Videos https://eref.thieme.de/e-videos E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos . Publication History Article published online: 04 December 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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