Abstract
A 57-year-old man underwent pancreatoduodenectomy for intraductal papillary mucinous neoplasm of the pancreas. After the surgery, a pancreatic fistula developed, and bloody drainage was observed on postoperative day 37. Angiography demonstrated a pseudoaneurysm at the stump of the gastroduodenal artery, and the patient was diagnosed as having postpancreatectomy hemorrhage (PPH) induced by rupture of the pseudoaneurysm. After confirming that the arterial blood flow to the liver was maintained even after clamping of the common hepatic artery and proper hepatic artery, embolization of the arteries was performed for control of the PPH. The treatment was successful, and the patient continued to be followed up. CT examination performed five months after the embolization revealed no recurrence of the pseudoaneurysm. However, eight months after the first interventional radiologic procedure, he visited our hospital again with abdominal discomfort. Abdominal CT examination showed a recurrent pseudoaneurysm at the confluence of the left and right hepatic arteries, which was located next to the treated proper hepatic artery. By the percutaneous transhepatic approach, Histoacryl and thrombin were injected into the pseudoaneurysm for embolization. The treatment was successful, and the patient remains alive without any recurrence of the pseudoaneurysm one year and one month after the treatment for the recurrent pseudoaneurysm.
