2018 Volume 33 Issue 5 Pages 826-833
The patient is an 86 year old woman who was diagnosed with carcinoma of the pancreatic head. She was followed without aggressive therapy, because of her advanced age. She had obstructive jaundice and a plastic stent (PS) was placed at the time of diagnosis, which was then exchanged to a self-expandable metallic stent (SEMS) two months later for occlusion. Eighteen days after SEMS placement, she presented with dizziness and melena. We performed upper and lower digestive endoscopy, but no obvious cause of bleeding was found. Thirty-seven days after SEMS placement, she presented in shock with recurrent melena. Enhanced computed tomography scan showed active bleeding near the duodenal papilla. A pseudoaneurysm of the posterior superior pancreatic duodenal artery (PSPDA) was found on emergency angiography, with extravasation into the duodenum and treated by transcatheter arterial embolization (TAE) using n-butyl-2-cianoacrylate. There was no recurrent bleeding for six months when she died of her primary disease. We report a rare patient with biliary bleeding from a pseudoaneurysm of the PSPDA after SEMS placement.
