2006 Volume 26 Issue 6 Pages 805-808
Two patients with ruptured aneurysms of the pancreaticoduodenal artery are presented. Case 1 was a 74-year-oldwoman who was admitted because of a sudden right abdominal pain. An abdominal computed tomography (CT) scanshowed a retroperitoneal hemorrhage, and an abdominal angiography showed a hemorrhage of the posterosuperiorpancreaticoduodenal artery. Since the insertion of a catheter into the lesion was difficult, we elected not to performtrans-arterial embolization (TAE). Instead, we performed a laparotomy and ligated the feeding arteries. Case 2 wasa 72-year-old man who was admitted to hospital because of a lower abdominal pain. A CT scan of his abdomen showeda retroperitoneal hemorrhage, and an abdominal angiography showed a hemorrhage of the anterioinferior pancreaticoduodenalartery. Since the insertion of a catheter into the lesion was difficult, we elected not to perform TAE.Instead, we performed a laparotomy and ligated the feeding arteries. Postoperative abdominal angiographies in bothcases showed stenosis of the basal portion of the celiac artery and the development of a collateral vessel from thesuperior mesenteric artery. We suspect that this condition caused the aneurysms of the pancreaticoduodenal artery.When a retroperitoneal hemorrhage is seen using abdominal CT, TAE after abdominal angiography is the treatmentof first choice because of its low invasiveness. In cases where cannulation at the point of bleeding is difficult, however, an operation should be performed as soon as possible.
