Inferior pancreaticoduodenal artery aneurysm rupture as a cause of haemoperitoneum – case report and review of the literature
Authors:
P. Skalický 1; M. Loveček 1; D. Klos 1; Č. Neoral 1; V. Prášil 2; L. Starý 3; K. Knápková 3; J. Tesaříková 3
Authors‘ workplace:
1. chirurgická klinika Fakultní nemocnice Olomouc
1; Radiologická klinika Fakultní nemocnice Olomouc
2; 1. chirurgická klinika Lékařské fakulty Univerzity Palackého, Olomouc
3
Published in:
Rozhl. Chir., 2021, roč. 100, č. 1, s. 32-36.
Category:
Case Report
doi:
https://doi.org/10.33699/PIS.2021.100.1.32–36
Overview
Introduction: Arterial aneurysms of the pancreaticoduodenal arcade (PDA) represent approximately 2% of all aneurysms of visceral arteries. Despite a low incidence, this group of aneurysms is clinically significant due to its high risk of rupture.
Case report: A 45 years old patient presented with a pancreaticoduodenal arcade aneurysm rupture along with a tight stenosis at the origin of the coeliac trunk. Retrograde blood flow from the superior mesenteric artery (SMA) to the hepatic artery (HA) via PDA limited our therapeutic options due to the necessity to maintain liver perfusion. The patient was indicated for an interventional radiology procedure, which consisted of percutaneous transluminal angioplasty (PTA) with stent placement at the origin of the coeliac trunk and subsequent transarterial embolisation (TAE) – trapping of the aneurysm using coils. Due to clinical signs of the intra-abdominal compartment syndrome, within 24 hours of the radiological treatment, the patient was indicated for surgical revision (laparotomy). During the surgery, no signs of active bleeding were found; coagula were evacuated from the abdominal cavity (800 ml) and laparostomy was performed with a temporary closure using a grid. Final closure of the abdominal cavity was performed on postoperative day 20 from the initial procedure. Follow-up abdominal CT performed 22 months after TAE showed no recurrence of the aneurysm.
Conclusion: Aneurysm rupture represents a serious case of acute abdomen which requires urgent treatment. The preferred method of treatment for ruptured PDA aneurysms is the endovascular intervention using TAE, which is associated with lower morbidity and mortality than the surgical intervention. Concurrent coeliac trunk stenosis requires consideration given the need to maintain sufficient liver perfusion after TAE of the PDA aneurysm, acting up to this point as a collateral circulation of the liver. The choice of the therapeutic approach should be individualised taking into account the above mentioned recommendations.
Keywords:
aneurysm of the pancreaticoduodenal artery – rupture − stenosis of the coeliac trunk
Sources
- Paty PS, Cordero JA, Darling RC, et al. Aneurysms of the pancreaticoduodenal artery. J Vasc Surg. 1996;23:710−713. doi:10.1016/s0741-5214(96)80054-1.
- de Perrot M, Berney T, Deleaval J, et al. Management of true aneurysms of the pancreaticoduodenal arteries. Ann Surg. 1999;229(3):416–420. doi:10.1097/00000658-199903000-00016.
- Kallamadi R, de Moya MA, Kalva SP. Inferior pancreaticoduodenal arteryaneurysms in association with celiac stenosis/occlusion. Sem Intervent Radiol. 2009;26(3):215–223. doi.org/10.1055/s-0029-1225671.
- Buresta P, Freyrie A, Paragona O, et al. Ruptured pancreaticoduodenal artery aneurysm. A case report and review of the literature. J Cardiovasc Surg. 2004;45:153–157.
- Takeuchi H, Isobe Y, Hayashi M, et al. Ruptured pancreaticoduodenal artery aneurysm with acute gangrenous cholecystitis: a case report and review of the literature. Hepatogastroenterology 2004;51:368–371.
- Mihara Y, Kubota K, Nemoto T, et al. Successful treatment for rupture of pancreaticoduodenal artery aneurysm: two case reports. Hepatogastroenterology 2005;52:264–269.
- Murata S, Tajima H, Fukunaga T, et al. Management of pancreaticoduodenal artery aneurysms: results of superselective transcatheter embolization. AJR Am J Roentgenol. 2006;187:290−298. doi:10.2214/AJR.04.1726.
- Lovecek M, Havlik R, Köcher M, et al. Pseudoaneurysm of the gastroduodenal artery following pancreatoduodenectomy. Stenting for hemorrhage. Wideochir Inne Tech Maloinwazyjne 2014;9(2):297−301. doi:10.5114/wiitm.2011.38178.
- Tarazov PG, Ignashov AM, Pavlovskij AV, et al. Pancreaticoduodenal artery aneurysm associated with celiac axis stenosis: combined angiographic and surgical treatment. Digestive Diseases and Sciences 2001;46(6):1232–1235. doi:10.1155/2017/6989673.
- Katsura M, Gushimiyagi M, Takara H, et al. True aneurysm of the pancreaticoduodenal arteries: a single institution experience. Journal of Gastrointestinal Surgery 2010;14(9):1409–1413. doi:10.1007/s11605-010-1257-0.
- Lasheras JC. The biomechanics of arterial aneurysms. Annual Review of Fluid Mechanics 2007;39:293–319. doi:10.1146/annurev.fluid.39.050905.110128.
- Mano Y, Takehara Y, Sakaguchi T, et al. Hemodynamic assessment of celiaco-mesenteric anastomosis in patients with pancreaticoduodenal artery aneurysm concomitant with celiac artery occlusion using flow-sensitive four-dimensional magnetic resonance imaging. European Journal of Vascular and Endovascular Surgery 2013;46(3):321–328. doi:10.1016/j.ejvs.2013.06.011.
- Brocker JA, Maher JL, Smith RW, et al. True pancreaticoduodenal aneurysms with celiac stenosis or occlusion. Am J Surg. 2012;204:762–768. doi:10.1016/j.amjsurg.2012.03.001.
- Sgroi MD, Kabutey NK, Krishnam M, et al. Pancreaticoduodenal artery aneurysms secondary to median arcuate ligament syndromemay not need celiac artery revascularization or ligament release. Annals of Vascular Surgery 2015;29(1):122–122. doi:10.1016/j.avsg.2014.05.020.
- Coll DP, Ierardi RT, Kerstein MD, et al. Aneurysms of the pancreaticoduodenal arteries: a change in management. Ann Vasc Surg. 1998;22:286–291. doi:10.1007/s100169900155.
- Morita Y, Hasegawa T, Hanawa M. Transcatheter arterial embolization for the pancreaticoduodenal artery aneurysms. IVR Int Radiol. 1999;14:334–342. doi:10.1007/s00270-003-0032-y.
- Suzuki K, Yasushi T, Ito S, et al. Endovascular management of ruptured pancreaticoduodenal artery aneurysms associated with celiac axis stenosis. Cardiovasc Intervent Radiol. 2008;31:1082–1087. doi:10.1007/s00270-008-9343-3.
- Fankhauser GT, Stone WM, Naidu SG, et al. The minimally invasive management of visceral artery aneurysms and pseudoaneurysms. J Vasc Surg. 2011;53:966−970. doi:10.1016/j.jvs.2010.10.071.
- Tulsyan N, Kashyap VS, Greenberg RK, et al. The endovascular management of visceral artery aneurysms and pseudoaneurysms. J Vasc Surg. 2007;45:276−283. doi:10.1016/j.jvs.2006.10.049.
- Tien YW, Kao HL, Wang HP. Celiac artery stenting: a new strategy for patients with pancreaticoduodenal artery aneurysm associated with stenosis of the celiac artery. Journal of Gastroenterology 2004;39(1):81–85. doi:10.1007/s00535-003-1251-3.
- Stambo GW, Hallisey MJ, Gallagher JJ. Arteriographic embolization of visceral artery pseudoaneurysms. Annals of Vascular Surgery 1996;10(5):476–480. doi:10.1007/BF02000596.
- Lossing AG, Grosman H, Mustard RA, et al. Emergency embolization of a ruptured aneurysm of the pancreaticoduodenal arcade. Canadian Journal of Surgery 1995;38(4):363–365.
- Savastano S, Feltrin GP, Miotto D, et al. Embolization of ruptured aneurysm of the pancreaticoduodenal artery secondary to long-standing stenosis of the celiac axis: case reports. Vascular and Endovascular Surgery 1995;29(4):309–314. doi:10.1177/153857449502900409.
- Flood K, Nicholson AA. Inferior pancreaticoduodenal artery aneurysms associated with occlusive lesions of the celiac axis: diagnosis, treatment options, outcomes, and review of the literature. Cardiovasc Intervent Radiol. 2013;36:578–587. doi:10.1007/s00270-012-0473-2.
- Sachdev-Ost S. Visceral artery aneurysms: review of current management options. Mount Sinai Journal of Medicine 2010;77(3):296–303. doi:10.1002/msj.20181.
- Izumi M, Rju M, Cho A, et al. Ruptured pancreaticoduodenal artery aneurysm treated by superselective transcatheter arterial embolization and preserving vascularity of pancreticoduodenal arcades. Journal of Hepato-Biliary-Pancreatic Surgery 2004;11(2):145–148. doi:10.1007/s00534-003-0859-2.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2021 Issue 1
Most read in this issue
- Cesarean scar endometriosis: our recent experiences
- Gas embolism after periproctal abscess incision and lavage with hydrogen peroxide − a case report Should the use of hydrogen peroxide in surgery be continued?
- Danger of bacterial translocation for a surgical patient
- Inferior pancreaticoduodenal artery aneurysm rupture as a cause of haemoperitoneum – case report and review of the literature