title: A case report of duodenal obstruction due to retroperitoneal bleeding after the rupture of a lower pancreaticoduodenal artery aneurysm.
abstract: We report a case of a patient with duodenal obstruction due to retroperitoneal bleeding after the rupture of a lower pancreaticoduodenal artery aneurysm. An 80-year-old female was admitted to our hospital because of nausea and vomiting. During hospitalization, she developed hemorrhagic shock. Enhanced computed tomography revealed retroperitoneal bleeding. Abdominal angiography revealed an 8-mm aneurysm of the lower pancreaticoduodenal artery, stenosis at the trunk of the celiac artery, and increased blood flow through the pancreaticoduodenal arcades from the superior mesenteric artery. Embolization using coils was successful. On day 24, the patient presented with vomiting. Imaging modalities revealed dilatation of the stomach and duodenum. Thus, duodenal obstruction due to the retroperitoneal hematoma was suspected. After percutaneous drainage of the retroperitoneal hematoma, the patient's symptoms improved. In the present case, the formation of the lower pancreaticoduodenal artery aneurysm was related to median arcuate ligament syndrome. After transcatheter embolization of a ruptured visceral aneurysm, obstruction of the gastrointestinal tract by hematoma should be meticulously evaluated.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kobe Tokushukai Hospital.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Takeuchi
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Emori
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Nomura
mesh_terms: D000369:Aged, 80 and over; D000783:Aneurysm; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000628:therapy; D001164:Arteriovenous Fistula / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D004380:Duodenal Obstruction / Q000209:etiology*; D004621:Embolization, Therapeutic; D005260:Female; D006406:Hematoma / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D006470:Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D006801:Humans; D012187:Retroperitoneal Space / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed