2019 Volume 44 Issue 5 Pages 979-984
A 69-year-old man with a distal cholangiocarcinoma underwent pancreaticoduodenectomy in our hospital. He developed bile leakage in the absence of the pancreatic fistula on postoperative day 7, which was treated conservatively by local drainage, and he was discharged on postoperative day 27. Seventeen days after discharge, he visited to our hospital again because of hematemesis. Enhanced abdominal computed tomography showed a 6-cm pseudoaneurysm without intraabdominal hemorrhage near the stump of the gastroduodenal artery, for which emergency angiography was performed, and the pseudoaneurysm was successfully treated by transcatheter arterial embolization. The patient was discharged on postoperative day 5 without complications. Few reports describe large pseudoaneurysms after pancreaticoduodenectomy, and the current case was the largest among the case reports in the past. We considered that vascular packing using the falciform ligament of the liver may be a useful technique to prevent rupture of the aneurysm.
