Abstract
A 50-year-old man visited our hospital with a complaint of epigastralgia and vomiting. Soon after he arrived at our hospital, he became unconscious and went into a state of shock with hypotension. Abdominal computed tomography showed hemorrhagic ascites and a huge hematoma behind the pancreas head. Three dimension-CT revealed 16mm of aneurysm in the anterior inferior pancreaticoduodenal artery (AIPDA). Because it was difficult for him to recover from a hypovolemic shock with intravenous infusion, an emergency operation was performed. At laparotomy, hemorrhagic ascites and extensive retroperitoneal hematoma around the head of the pancreas was seen. We found the active bleeding of the AIPDA and diagnosed that it was caused from a rupture of the aneurysm of the AIPDA. Ligation of the aneurysm was performed. After the operation, slight bleeding continued and postoperative angiography was performed. No active bleeding was found but the inferior pancreaticoduodenal artery was embolized to avoid re-bleeding. Pancreaticoduodenal artery aneurysm (PDAA) is an uncommon visceral artery aneurysm and ruptured aneurysms result in fatal hemorrhage and high mortality. We herein report a case of ruptured PDAA that was treated successfully by surgery and transcatheter embolization. We also review 103 cases reports on PDAA reported in Japanese literature.
