Four Cases of Delayed Duodenal Stenosis after Retroperitoneal Hemorrhage from the Pan-creatic Duodenal Artery with Spontaneous Improvement

Abstract

Rupture of a small aneurysm in the pancreatic arcade associated with segmental arterial me-diolysis (SAM) or median arcuate ligament compression syndrome has been increasingly treated with transcatheter arterial embolization in recent years. Although the retroperitoneal hematoma is gradually resorbed, severe duodenal obstruction may occur during this process. In our 4 cases, the obstruction resolved spontaneously after 4 to 5 weeks, and no necrosis or ulceration of the mucosa was observed at any time. Furthermore, in one of the four cases, no embolization was performed, suggesting that embolization may not be the direct cause of duodenal obstruction. In this study, we analyze our cases and discuss the mechanism of delayed duodenal stenosis after retroperitoneal hemorrhage in the pancreaticoduodenal arcade region and its relation to vascular embolization.