A Case of Rupture of a Pseudoaneurysm of the Cystic Artery towards the Reconstructed Jejunum after Pancreaticoduodenectomy

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  • ENDO Fumitaka
    Department of Surgery, Morioka Municipal Hospital Department of Surgery, Iwate Medical University, School of Medicine
  • SUTO Takayuki
    Department of Surgery, Morioka Municipal Hospital
  • KOJIKA Masahiro
    Department of Surgery, Iwate Medical University, School of Medicine
  • ISHIDA Kaoru
    Department of Surgery, Iwate Medical University, School of Medicine
  • NITTA Hiroyuki
    Department of Surgery, Iwate Medical University, School of Medicine
  • SASAKI Akira
    Department of Surgery, Iwate Medical University, School of Medicine

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Other Title
  • 小腸に穿破した膵頭十二指腸切除術後の胆嚢動脈仮性動脈瘤の1例
  • 症例 小腸に穿破した膵頭十二指腸切除術後の胆囊動脈仮性動脈瘤の1例
  • ショウレイ ショウチョウ ニ センハシタ スイトウ ジュウニシチョウ セツジョ ジュツゴ ノ タンノウ ドウミャク カセイ ドウミャクリュウ ノ 1レイ

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Abstract

The patient was a 73-year-old woman who had been diagnosed as having cancer of the pancreatic head and undergone pylorus-preserving pancreaticoduodenectomy. Thirteen days after the operation, the patient developed hepatorrhagia ; she was treated by drainage and antibiotic therapy, however, 28 days after the operation, she developed melena.<BR>An emergency colonoscopy failed to identify the source of bleeding. Considering the stable general condition of the patient, she was merely followed up. At 33 days after the operation, melena occurred again, and an angiographic examination was performed, which revealed extravasation from a pseudoaneurysm of the cystic artery in the reconstructed jejunum near the choledochojejunostomy. Under the diagnosis of ruptured aneurysm of the cystic artery in the reconstructed jejunum, the right hepatic artery was embolized using microcoils, and the bleeding was successfully controlled. After the embolization, the clinical progress was satisfactory, and the patient was discharged from the hospital on day 50 after the operation. In patients developing an intraabdominal abscess after operation, the serious complication of a pseudoaneurysm/pseudoaneurysmal rupture could occur. It is important for an angiographic examination to be performed in cases of intraabdominal bleeding and gastrointestinal bleeding, to obtain an early diagnosis and administer prompt treatment.

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