A case of a ruptured pancreaticoduodenal arterial anerysm with cacs in the pancreas head treated with pancreaticoduodenectomy

Abstract

We report a case of a ruptured aneurysm of the pancreaticoduodenal artery with celiac axis compression syndrome (CACS).
An 83–year–old woman was admitted to our hospital because of the sudden onset of hematemesis. Abdominal CT scan demonstrated an aneurysm in hematoma in the pancreas head. Angiography revealed an aneurysm of the inferior pancreaticoduodenal artery and obstruction of the celiac artery. Transcatheter embolization was unsuccessful because of arteriosclerosis, therefore operative procedure was proceeded. In the operation, as extrinsic compression to the celiac artery by the median arcuate ligament was revealed, decompression was made by releasing it. Furthermore, after confirming common hepatic arterial blood flow was enough and hepatopetal with electromagnetic flowmetry, we safely performed pylorus–preserving pancreaticoduodenectomy. The patient′s postoperative course was uneventful. In the treatment of ruptured pancreaticoduodenal aneurysms with celiac axis occlusion, we should bear in mind that intraoperative careful monitoring of hepatic arterial blood flow is necessary considering the possible involvement of CACS.
Key words : celiac axis compression syndrome (CACS), Ruptured aneurysm of pancreaticoduodenal artery, Pylorus preserving pancreaticoduodenectomy (PpPD)