2018 Volume 67 Issue 2 Pages 103-110
We experienced a case of postoperative ruptured pseudoaneurysm of the gastroduodenal artery, which could be successfully managed by means of transcatheter arterial embolization.
A 58-year-old man underwent pancreaticoduo-denectomy with a modified Child’s reconstruction for advanced pancreas head carcinoma（T4N1M0StageⅣA）．On the 21th day after the operation, suddenly he had an abdominal pain and had a rapid decrease in blood pressure to 60mmHg mark. Emergency endoscopy faild to reveal any sources of bleeding. CT revealed a large amount of hematomas and coagulations in the abdominal cavity and the gastrointestinal tract. Contrastenhanced CT and angiography also showed a pseudoaneurysm on the stump of the gastroduodenal artery, which had no extravasation and was successfully embolized using microcoils. Thereafter his clinical course was uneventful and was discharged on 20 days after TAE. A right hepatic artery branched off from SMA in this case, so there were no appearance of liver abscess or liver infarction after TAE. This case had no clinical symptom of postoperative ruptured pseudoaneurysm. So we probably should perform CT examination at short interval after PD for early diagnosis and early treatment of unruptured pseudoaneurysm. An acute abdomen after PD should be considered possibly due to rupture of the pseudoaneurysm of the celiac artery branches. The cooperation closely among surgery and internal medicine and interventional radiology should be necessary to treat ruptured pseudoaneurysm.
