A Case of Successful Tae Using N-butyl-2-cyanoacrylate for Pseudoaneurysm Caused by Pancreatic Fistula, which was Difficult to Embolize Using the Coil

Abstract

An 83-year-old man underwent surgery for malignant lymphoma extending from the third portion of the duodenum to the upper jejunum. Tumor intestinal resection and gastrointestinal reconstruction were performed. Postoperative pancreatic fistula occurred as a complication, and a large amount of blood leaked out through the drain on the 9^th postoperative day. Emergency angiography was performed, and pseudoaneurysm formation was suspected in the arterial arcade of the pancreatic head. Coil embolization was difficult, and there were no active bleeding sites. Therefore, conservative treatment with a hemostatic infusion was performed. A large amount of bloody drainage from the drain was observed again on the 15^th postoperative day. Therefore, angiography was performed again, and pseudoaneurysm formation was more clearly observed this time. The pancreatic head artery arcade, including the pseudoaneurysm, was selectively embolized using N-butyl-2-cyanoacrylate (NBCA), and no rebleeding was observed thereafter.

This patient was elderly and had experienced two episodes of bleeding from a pseudoaneurysm, and his general condition was poor. Hemostasis by reoperation was risky due to the complication of a pancreatic fistula. Hemostasis with NBCA could be a promising treatment option for patients with poor general conditions in which coil embolization is difficult.