Successful Hemostasis of a Ruptured Inferior Pancreaticoduodenal Artery Aneurysm by Transcatheter Arterial Embolization

Abstract

A 71-year-old man was brought to the emergency room with upper abdominal pain. On arrival, there was abdominal tenderness on palpation, mainly in the umbilical region. Contrast-enhanced computed tomography (CECT) showed a hypodense area extending from around the pancreas to the retroperitoneum. He was admitted with suspected acute pancreatitis, duodenal perforation, retroperitoneal tumor, or similar condition, but, after several hours, his vital signs deteriorated and he went into shock. Repeated CECT showed expansion of the hypodense area and pooling of contrast agent below the head of the pancreas. A ruptured inferior pancreaticoduodenal artery aneurysm was suspected, and emergency abdominal angiography was performed. A 10-mm aneurysm of the inferior pancreaticoduodenal artery was observed, and transcatheter arterial embolization (TAE) with a metal coil was carried out. Following TAE, a hematoma appeared that caused compression of the duodenum and stenotic symptoms, but these improved by conservative therapy with fasting and nasogastric tube placement, and the patient was discharged on postoperative Day 52. There have been no subsequent signs of recurrence.