title: Surgical Resection of a Ruptured Pancreaticoduodenal Artery Aneurysm.
abstract: BACKGROUND
  Ruptured aneurysms of the pancreaticoduodenal artery result in fatal hemorrhage and high mortality. Therefore, prompt diagnosis and treatment are required, but there are sometimes problems differentiating this specific diagnosis from other abdominal pathologies.
  
  
  METHODS
  We encountered a rare case of a ruptured pancreaticoduodenal artery aneurysm with an atypical clinical presentation that simulated acute pancreatitis. A 71-year-old woman was admitted to the emergency department with abdominal pain in the left upper quadrant, a slightly elevated level of pancreatic amylase, and cholelithiasis on ultrasonography. With persistent pain and progressively decreasing hemoglobin level, computed tomography with contrast showed fluid collection in the subphrenic space, a retroperitoneal hematoma, and a pancreaticoduodenal artery aneurysm that appeared to originate from a branch of the SMA. Urgent angiography indicated spontaneous rupture of a pancreaticoduodenal artery aneurysm. Emergent surgery was undertaken, and a simple aneurysmectomy was successfully performed. The patient's recovery was unremarkable. The prompt diagnosis of a pancreaticoduodenal artery aneurysm was difficult because the initial symptoms were vague and misleading in our case.
  
  
  CONCLUSIONS
  A high level of suspicion, rapid diagnostic capability, and prompt surgical or endovascular intervention, as well as effective teamwork in the emergency department, are critical to avoid the devastating consequences of a ruptured visceral artery aneurysm.
authors.affiliation: Department of Emergency, Fujisawa Shounandai Hospital, Fujisawa, Japan.
authors.forename: Tomohide
authors.initials: T
authors.lastname: Takei
authors.affiliation: Department of Emergency, Fujisawa Shounandai Hospital, Fujisawa, Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Sakai
authors.affiliation: Department of Radiology, Fujisawa Shounandai Hospital, Fujisawa, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Surgery, National Hospital Organization Yokohama Medical Center, Yokohama, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, National Hospital Organization Yokohama Medical Center, Yokohama, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ogasawara
authors.affiliation: Department of Surgery, National Hospital Organization Yokohama Medical Center, Yokohama, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Shimizu
authors.affiliation: Department of Emergency, Fujisawa Shounandai Hospital, Fujisawa, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Imaizumi
authors.affiliation: Department of Critical care and Emergency Medicine, National Hospital Organization Yokohama Medical Center, Yokohama, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Furuya
authors.affiliation: Surgery, National Hospital Organization Yokohama Medical Center, Yokohama, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sekido
authors.affiliation: Department of Emergency, Fujisawa Shounandai Hospital, Fujisawa, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Koizumi
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D000681:Amylases / Q000378:metabolism; D017542:Aneurysm, Ruptured / Q000175:diagnosis* / Q000601:surgery*; D000792:Angiography; D001158:Arteries; D002769:Cholelithiasis / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D004386:Duodenum / Q000098:blood supply*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D010179:Pancreas / Q000098:blood supply*; D010195:Pancreatitis / Q000175:diagnosis; D014463:Ultrasonography
chemical_list: D006454:Hemoglobins; D000681:Amylases