2017 Volume 37 Issue 7 Pages 1087-1091
A 66-year-old man presented with a ruptured aneurysm of the posterior superior pancreaticoduodenal artery (PSPDA). He was admitted to our hospital with abdominal pain and vomiting. Angiography showed the PSPDA aneurysms were defined. We performed therapeutic coil embolization for the PSPDA aneurysms. Abdominal bloating and vomiting appeared on the ninth day after transarterial embolization (TAE), and an upper gastrointestinal examination revealed stenosis and transit obstruction associated with duodenal edema. A feeding tube was inserted and conservative treatment was continued. He developed fever and jaundice on the 27th day after TAE, diagnosed as acute cholangitis with blood test and abdominal contrast CT examination, and percutaneous transhepatic gallbladder drainage was performed. The cholangitis improved promptly. Duodenal narrowing slowly improved and the patient was discharged on day 52 after TAE. We believe that the historical and imagery diagnosis was segmental arterial mediolysis (SAM). After the angiogram the patient was complicated with delayed duodenal stenosis and cholangitis. This is a rare case with few previous reports. Additionally, TAE caused stenosis due to edema of the duodenum, it seems that if the edema reaches the papilla of Vater, biliary excretion disorder causes cholangitis.
