Successful Non–surgical Treatment for Repeated Inferior Pancreaticoduodenal Artery Aneurysms: A Case Report

Abstract

A 58–year–old man visited another hospital complaining of right hypochondralgia and vomiting. An abdominal enhanced computed tomography (CT) examination showed a retroperitoneal hematoma behind the pancreas head associated with a ruptured aneurysm in the posterior inferior pancreaticoduodenal artery (PIPDA). He was urgently transferred to our hospital, and transcatheter arterial embolization (TAE) for the PIPDA aneurysm was performed. On day 14 after admission, a second CT examination revealed new aneurysms in the anterior inferior pancreaticoduodenal artery (AIPDA), and the aneurysms were also treated with TAE. On day 16, the patient developed vomiting. An upper gastrointestinal endoscopy revealed an edematous stenosis at the inferior duodenal angle, and a nasogastric drainage tube was inserted. On day 21, percutaneous transhepatic gall bladder drainage was performed because of jaundice, elevated serum biliary enzyme and amylase levels, and cholecystic enlargement on CT. After symptom improvement, a transnasal feeding tube was inserted into the jejunum and enteral nutritional treatment was continued. The duodenal narrowing was gradually improved, and oral intake could be restarted. He was discharged on day 48. He is currently in good condition with no signs of aneurysm recurrence for 2 years since the treatment.