2024 Volume 49 Issue 1 Pages 16-21
A 76-year-old man with an elevation in liver transaminase enzymes. liver dysfunction was admitted to our hospital. An enhanced contrast CT and endoscopic retrograde cholangiography showed that hilar cholangiocarcinoma was highly suspected. Further laboratory investigations showed elevated biliary enzyme levels without jaundice. Based on these findings, Bismuth type IIIa was suspected. Therefore, the patient underwent operation after percutaneous transhepatic portal vein embolization. On postoperative day (POD) 6, the patient had a life-threatening shock. The CT and interventional radiological findings showed a raptured aneurysm of posterior superior pancreatoduodenal artery (PSPDA). Thereafter, on POD 17, the patient had an aneurism close to the previous location of the PSPDA. Generally, aneurysms are clinically caused by bile or pancreatic juice leakage. This case served as an important reminder to consider heat arterial damages caused by energy devices when lymph node dissection is performed around the pancreatic head.
