A Case of a Superior Mesenteric Artery Pseudoaneurysm after Pancreatoduodenectomy: Effectiveness of the Balloon Occlusion Test before Embolization

Abstract

Pseudoaneurysm is one of the severe complications after pancreatoduodenectomy (PD) and ruptured pseudoaneurysms are often fatal. Interventional radiology plays an important role in the treatment of pseudoaneurysm, and organ ischemia by embolization should be avoided. Balloon occlusion test is an effective technique to simulate circulation post embolization and is also useful to judge whether to perform embolization without any complications.
Bloody ascites was found in the drainage tube in a man in his 60’s with pancreatic fistula on the 17th day after PD. An emergency CT was performed and pseudoaneurysms were found on the superior mesenteric artery (SMA). An angiogram showed a fusiform aneurysm and two saccular aneurysms on the SMA.
The SMA was seen through collateral circulation on the inferior mesenteric angiogram with balloon-occlusion in the SMA. There were no abdominal symptoms for 30 minutes while a balloon occluded the SMA. Therefore, embolization for the SMA pseudoaneurysms was performed. As a result, there have been no abdominal symptoms or recurrences of pseudoaneurysms for 22 months after the embolization.