2019 Volume 44 Issue 2 Pages 291-298
A 71-year-old man was admitted to our hospital with severe abdominal pain and was diagnosed as having acute pancreatitis. After further examination, he was also diagnosed as having a branch-duct type of IPMN. Since the pancreatic cystic tumor showed some worrisome features and the patient was a heavy drinker, he was given some temperance guidance. Although he completely stopped drinking, the pancreatitis recurred four months later, with the IPMN suspected as the cause of the pancreatitis. We performed subtotal stomach-preserving pancreatoduodenectomy. We injured the right hepatic artery during the operation and sutured it for hemostasis. Postoperatively, a pancreatic fistula developed and the patient presented with chest pain followed by melena on the 16th postoperative day. Esophagogastroduodenoscopy (EGDS) revealed a small ulcer with an exposed artery in the region of the gastrojejunostomy and clipping was performed for hemostasis. However, melena following chest pain recurred on the 19th, 29th and 32th days, suggesting the existence of an association between the chest pain and melena. Therefore, we performed enhanced chest CT immediately after the patient complained of chest pain on the 37th day, which revealed extravasation from the right hepatic artery into the jejunum． We performed angiography and made the diagnosis of penetration of the right hepatic artery aneurysm into the jejunum. Then, we successfully performed transcatheter arterial embolization of the right hepatic artery.
