Summary
Inferior pancreaticoduodenal artery (PDA) aneurysms are rare: To date, only 88 cases have been reported in the English literature. Although atherosclerosis represents the most common histological finding (60%), the pathogenetic mechanism consists usually of vessel erosion owing to acute or chronic pancreatitis. Most of these lesions are undetectable until symptoms of rupture occur. Rupture occurs typically in association with an episode of pancreatitis (60%) and carries a high mortality rate (50%), making diagnosis and early treatment essential. Angiography and computed tomography (CT) readily confirm the diagnosis. Ligation or resection of the aneurysm represents the definitive and radical therapy, but in an emergency, entails a high mortality rate (50%). Transcatheter embolization is a valid alternative to control bleeding (80%) in order to stabilize the patient; in some cases, it represents a definitive treatment We present a case of an aneurysm that developed in a patient who had had posttraumatic acute pancreatitis. A surgical procedure with proximal and distal ligation of the aneurysm was performed successfully.
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References
Stanley JC, Zelenoch GB. Splanchnic artery aneurysms, inVascular Surgery, Rutherford RB, ed. WB Saunders, Philadelphia, 1989; pp. 969–982.
Gadacz TR, Trunkey D, Kieffer RF. Visceral vessel erosion associated with pancreatitis: case reports and a review of the literature.Arch Surg 1978; 113: 1438–1440.
Eckhauser FE, Stanley JC, Zelenock GB, Borlaza GS, Freier DT, Lindenauer SM. Gastroduodenal and pancreatic-oduodenal artery aneurysms: a complication of pancreatitis causing spontaneous gastrointestinal hemorrhage.Surgery 1980; 88: 335–344.
Iyomasa S, Matsuzaki Y, Hiei K, Sakaguchi H, Matsunaga H, Yamaguchi Y. Pancretticoduodenal artery aneurysm: a case report and review of the literature.J Vasc Surg 1995; 22: 161–166.
Ferguson F. Aneurysm of the superior pancreaticoduodenal artery with perforation into the common bile duct.Proc NY Pathol Soc 1895: 24.
Chiou AC, Josephs LG, Menzoian JO. Inferior pancreatic-oduodenal artery aneurysm: report of a case and review of the literature.J Vasc Surg 1993; 17: 784–789.
Davies N, Adamson A, Johnson CD. Recurrent pancreatitis in the presence of a visceral artery aneurysm.J R Soc Med 1991; 84: 235,236.
Stanley JC, Frey CF, Miller TA. Major arterial hemorrhage: a complication of pancreatic pseudocysts and chronic pancreatitis.Arch Surg 1976; 111: 435–440.
White AF, Baum S, Buronasiri S. Aneurysms secondary to pancreatitis.Am J. Roentgenol 1976; 127: 393.
Sutton D, Lawton G. Coeliac stenosis or occlusion with aneurysm of the collateral supply.Clin Radiol 1973; 24: 49–53.
Kadir S, Athanasoulis HY, Wilkow H. Aneurysms of the pancreaticoduodenal arteries in association with coeliac axis occlusion.Cardiovasc Radiol 1978; 1: 173–177.
Crummy AB, Strother CM, Sackett JF. Computerized fluoroscopy: digital subtraction for intravenous angiocar-diography and arteriography.Am J Roentgenol 1980; 135: 1131–1140.
Gangahar DM, Corveth SW, Reese HE, Buchmann RJ, Breiner MA. True aneurysm of the pancreaticoduodenal artery: a case report and a review of the literature.J Vasc Surg 1985; 2: 741,742.
Forster DR. Inferior pancreaticoduodenal artery aneurysm presenting in a young woman.Br J Radiol 1985; 58: 1127–1129.
Stanley JC, Eckhauser FE, Whitehouse WM, Zelenock GB. Pancreatitis related splanchnic arterial microaneurysm and macroaneurysm, inPancreatic Disease. Deut TL, Eckhauser FE, Vinik AI, Turcotte JG, eds. Grune & Stratton, New York, 1981; pp. 315–341.
Verta MJ, Dean RH, Yao JST, Conn J, Mehn WH, Bergan JJ. Pancreaticoduodenal artery aneurysm.Ann Surg 1977; 186: 111–114.
Stabile BE, Wilson SE, Debas HT. Reduced mortality from bleeding pseudocysts and pseudoaneurysms caused by pancreatitis.Arch Surg 1983; 118: 45–51.
Starling JR, Crummy AB. Hemosuccus pancreaticus secundary to ruptured splenic artery aneurysm.Dig Dis Sci 1979; 24: 726–729.
Steckmann ML, Dooley MC, Jacques PF. Major gastrointestinal hemorrhage from peripancreatic blood vessels in pancreatitis: treatment by embolotherapy.Dig Dis Sci 1984; 29: 486–497.
Kolt S, Wise A. Embolisation in the management of peripancreatic pseudoaneurysms: a case report.Australas Radiol 1992; 36: 65–67.
Mandel SR, Jaques PF, Mauro MA, Sanofsky S. Non-operative management of peripancreatic artery aneurysms: a 10-year experience.Ann Surg 1987; 205: 126–128.
Morita R, Muto N, Konagaya M. Successful transcatheter embolisation of pseudoaneurysm associated with pancreatic pseudocyst.Am J Gastroenetrol 1991; 86: 1264–1267.
Thakker RV, Gajjar B, Wilkins RA. Embolisation of gastroduodenal artery aneurysm caused by chronic pancreatitis.Gut 1983; 24: 1094–1098.
Lina JR, Jacques PF, Mandell V. Aneurysm rupture secondary to transcatheter ambolisation.Am J Roentgenol 1979; 132: 553–556.
Uflacker R, Diehl JC. Successful embolisation of a bleeding splenic artery pseudoaneurysm secondary to necrotising pancreatitis.Gastrointest Radiol 1982; 7: 379–382.
Robert Y, Dubrulle F, Chambon JP, Wurtz A, Lemaitre L. Iatrogenic aneurysm of the hepatic artery. Treatment by percutaneous injection of thrombin and selective arterial embolisation.Ann Chir 1994; 48: 210–213.
Panayiotopoulos YP, Assadourian R, Taylor PR. Aneurysms of the visceral and renal arteries.Am R Coll Surg Engl 1996; 78: 412–419.
Harris RD, Anderson JE, Coel MN. Aneurysms of the small pancreatic arteries: a cause of upper abdominal pain and intestinal bleeding.Diagn Radiol 1975; 115: 17–20.
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Formentini, A., Birk, D., Kunz, R. et al. Inferior pancreaticoduodenal artery aneurysm as a consequence of traumatic acute pancreatitis. Int J Gastrointest Canc 21, 263–267 (1997). https://doi.org/10.1007/BF02821614
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DOI: https://doi.org/10.1007/BF02821614