Abstract
A 72-year-old female suffered acute abdominal pain and underwent computed tomography at a local clinic. The CT scan identified a retroperitoneal and colon mesenteric hematoma, a pancreaticoduodenal artery aneurysm in the hematoma, and no extravasation of contrast medium. The patient was sent to our hospital emergency department by ambulance. An emergency abdominal angiography was performed and showed a ruptured aneurysm originating from the inferior pancreaticoduodenal artery. Catheter embolization was performed from the superior mesenteric artery with micro-coils and the postoperative condition was stable. On arrival, the patient had a fever and C-reactive protein was high in the first set of laboratory data. Hemoculture was positive for Streptococcus anginosus which is part of the normal oral flora, and a carbapenem antibiotic was quickly administered. The patient had had submaxillary swelling and referred pain for three months, therefore we thought that a submaxillary abscess which was associated with a decayed tooth had caused the infectious aneurysm. The patient then suffered from duodenal stenosis due to a hematoma, so long-term fasting, insertion of a gastric tube and total parenteral nutrition was required. We report herein on a rare case of a pancreaticoduodenal artery aneurysm rupture suspected as having been caused by infection from a decayed tooth.
