Ruptured Pancreaticoduodenal Artery Aneurysm

(Division of Vascular Surgery, Department of Surgery (E2), Osaka University Graduate School of Medicine, Suita, Japan and Division of Vascular Surgery, Higashi Takarazuka Satoh Hospital*, Takarazuka, Japan)

Takashi Shibuya* Tomio Kawasaki
A 59-year-old man was admitted with sudden onset of back pain and abdominal discomfort. There was no history of pancreatitis, abdominal injury, or abdominal surgery. Enhanced abdominal computed tomography (CT) showed retroperitoneal hematoma behind the head of the pancreas, and emergency angiography demonstrated retroperitoneal bleeding due to rupture of a superior pancreaticoduodenal artery aneurysm. Embolization was tried unsuccessfully, because of difficulty in selective cannulation of the vessel feeding the aneurysm. Emergency laparotomy was performed. We inserted a finger behind the pancreas via the lateral side of the duodenum by Kocher's maneuver, then ligated the ruptured portion of the superior pancreaticoduodenal artery. We did not reconstruct the artery because blood supply to the peripheral tissue was good. The patient's postoperative course was uneventful, and he was discharged from the hospital in good condition 1 month after surgery. CT proved to be useful in revealing the voluminous retroperitoneal hematoma, and angiography proved to be necessary for the definitive diagnosis of pancreaticoduodenal artery aneurysm.
@Jpn. J. Cardiovasc. Surg. 32: 343 -346 (2003)