A Case of Ruptured Pseudoaneurysm of the Gastroduodenal Artery Developing after Extended Left Hepatectomy Successfully Treated by Transcatheter Arterial Coil-embolization after Stenting of a Hepatic Artery

Abstract

A 67-year-old patient diagnosed as having hilar cholangiocarcinoma (Bismuth-Corlette classification type 2) was treated by extended left hepatectomy with caudate lobectomy, and lymph node dissection. There were no postoperative complications. However, on the 14th postoperative day, bloody discharge was noted at the site of insertion of the drainage tube. It stopped spontaneously, however, on the 21th postoperative day, blood was noted, associated with a fall of the blood pressure. Emergency enhanced CT showed a pseudoaneurysm (15 mm) of the gastroduodenal artery. Angiography was performed immediately. First, we introduced a coronary non-covered stent (4 ×15 mm) through the common hepatic artery into the right hepatic artery to prevent blood flow in the liver. Then, we successfully embolized the pseudoaneurysm by a micro catheter inserted into the gastroduodenal artery through a slit of the stent. The patient's condition showed improvement in response to this treatment.