Percutaneous thrombin injection under sonographic guidance for exclusion of non-catheterizable post-pancreatitis pseudoaneurysm of the superior mesenteric artery: a minimally invasive and expeditious treatment option

Post-pancreatitis pseudoaneurysms are not uncommon. They have a high associated mortality due to a propensity to rupture. Current standards of treatment advocate immediate intravascular interventions. We describe two cases of alcohol-related post-acute pancreatitis pseudoaneurysms arising from the second-order branches of the superior mesenteric artery (SMA) that were endoluminally inaccessible. Both cases were successfully treated with percutaneous thrombin injection into the pseudoaneurysm sac under ultrasound guidance. We suggest that endoluminally inaccessible pseudoaneurysms that are percutaneously accessible can be expeditiously treated with percutaneous thrombin injection. Further, due to the efficaciousness of this procedure, it could be considered as a first-line minimally invasive therapeutic option.