Abstract
A rare case of a postoperative aneurysm of the pancreaticoduodenal artery which ruptured into the duodenum after laparoscopic distal gastrectomy. An 81-year-old man underwent endoscopic submucosal dissection at another hospital for treatment of early gastric cancer. Gastrectomy with lymph node dissection was recommended due to pathological submucosal invasion. A laparoscopic distal gastrectomy with regional lymphadenectomy, followed by Roux-Y reconstruction was performed, and the operative procedure was uneventful. Postoperative inflammation and subsequent blood examination determined that prolonged antibiotics therapy was necessary for peripancreatitis and the mesenteric panniculitis. Suddenly, on the 25th postoperative day, he developed shock after melena. Abdominal contrast-enhanced CT was revealed a rupture of the pancreaticoduodenal artery aneurysm into the duodenum lumen, and selected interventional radiology was performed. A 13×10 mm aneurysm was identified in the anterosuperior pancreaticoduodenal artery, and arterial embolizaion was successfully performed by injecting N-butyl-2-cyanoacrylate (Histoacryl) and microcoils into the anterosuperior pancreaticoduodenal artery. To our knowledge, pancreaticoduodenal pseudoaneurysm perforating the duodenum after laparoscopic distal gastrectomy is rare. But gastrointestinal bleeding after laparoscopic gastrectomy should be considered, possibly due to rupture of the pseudoaneurysm of the pancreaticoduodenal artery.
