Endovascular therapy as a treatment for ruptured pancreaticoduodenal artery aneurysms.
Pancreaticoduodenal artery aneurysms (PDAAs) are uncommon. The treatment and prognosis for ruptured PDAAs have changed in recent years. A demonstrative case is reported. A review of the literature has been made and the case of a healthy man operated on an emergency basis because of a massive hemoperitoneum secondary to a ruptured PDAA is reported and analyzed with regard to the clinical presentation, radiologic findings, management, and outcome. A bleeding point was not detected at operation. An intraoperative arteriogram did not show active bleeding. The pancreas appeared infiltrated and oozing blood. The abdomen was gauze packed and the patient transferred for endovascular therapy (ET). Then, an arteriogram showed a bleeding PDAA. After embolization, bleeding ceased and the patient recovered. According to our literature survey, less than 200 cases of true and false PDAAs have been reported. For ruptured PDAAs, surgery is associated with high mortality since the bleeding point is usually not identified at operation. Similarly, intraoperative arteriograms are often fruitless due to the patient's poor hemodynamics plus suboptimal quality of the portable equipment. As shown in the present case and according to the specialized medical literature, ET has often been successful in the management of these patients and may be chosen as a first option for the treatment of ruptured PDAAs.
Department of Surgery ,  Hospital "Clínico San Carlos", Madrid ,  Spain.
Oscar
O
Cano-Valderrama
Juan José
JJ
Gallego-Béuter
Manuel
M
Giner
D000328:Adult; D017542:Aneurysm, Ruptured / Q000628:therapy*; D004386:Duodenum / Q000098:blood supply; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D006465:Hemoperitoneum / Q000209:etiology; D006801:Humans; D008297:Male; D010179:Pancreas / Q000098:blood supply; D016896:Treatment Outcome