title: Ruptured pancreaticoduodenal artery aneurysm treated by superselective transcatheter arterial embolization and preserving vascularity of pancreaticoduodenal arcades.
abstract: We report a case of a ruptured aneurysm in the anterior superior pancreaticoduodenal artery (PDA) with hypovolemic shock managed successfully by superselective transcatheter arterial embolization of the aneurysm. A 75-year-old male presented to our hospital with hematemesis and melena. On admission, he was in shock. Angiography showed an aneurysm about 1 cm in diameter in the anterior superior PDA. However, extravasation of contrast medium was not seen owing to hypovolemic shock. A catheter was inserted into the aneurysm, and superselective microcoil embolization of the PDA aneurysm was successfully achieved. After the microcoil was inserted into the aneurysm itself, it was observed that duodenal vascularity and pancreaticoduodenal arcades were preserved and aneurysm was not present. There was no complication such as necrosis or abscess formation in the pancreas. The patient recovered and is doing well after 18 months of follow-up. Superselective transcatheter arterial embolization should be considered as the initial treatment of choice for all peripancreatic aneurysms.
authors.affiliation: Department of Surgery, Chiba Prefectural Sawara Hospital, 2285 Sawara I, Sawara, Chiba 287-0003, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Izumi
authors.forename: Munemasu
authors.initials: M
authors.lastname: Ryu
authors.forename: Akihiro
authors.initials: A
authors.lastname: Cho
authors.forename: Rajesh
authors.initials: R
authors.lastname: Gupta
authors.forename: Vinoud
authors.initials: V
authors.lastname: Tiku
authors.forename: Wataru
authors.initials: W
authors.lastname: Takayama
authors.forename: Taichi
authors.initials: T
authors.lastname: Kawashima
authors.forename: Shinichi
authors.initials: S
authors.lastname: Okazumi
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000628:therapy*; D004386:Duodenum / Q000098:blood supply*; D004621:Embolization, Therapeutic; D006801:Humans; D008297:Male; D010179:Pancreas / Q000098:blood supply*; D019736:Prostheses and Implants; D012769:Shock / Q000209:etiology