Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2019; 7(18): 2851-2856
Published online Sep 26, 2019. doi: 10.12998/wjcc.v7.i18.2851
Inferior pancreaticoduodenal artery pseudoaneurysm in a patient with calculous cholecystitis: A case report
Qiao-Dong Xu, Song-Gang Gu, Jia-Hong Liang, Shao-Dong Zheng, Zhi-Hua Lin, Pei-Dong Zhang, Jiang Yan
Qiao-Dong Xu, Song-Gang Gu, Jia-Hong Liang, Shao-Dong Zheng, Zhi-Hua Lin, Pei-Dong Zhang, Jiang Yan, Department of Biliary-Pancreatic Minimally Invasive Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
Author contributions: Xu QD and Gu SG contributed equally to this article; Xu QD and Gu SG wrote the case report portion and edited the final manuscript; Liang JH, Zheng SD, and Lin ZH reviewed and edited the final manuscript; Zhang PD and Yan J wrote the discussion portion and reviewed and edited the final manuscript.
Informed consent statement: Informed consent was obtained from the patient.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jiang Yan, MD, Professor, Department of Biliary-Pancreatic Minimally Invasive Surgery, The First Affiliated Hospital of Shantou University Medical College, No. 57, Changping Road, Shantou 515041, Guangdong Province, China. jyan@stu.edu.cn
Telephone: +86-754-88905186 Fax: +86-754-88905186
Received: April 8, 2019
Peer-review started: April 8, 2019
First decision: June 10, 2019
Revised: July 26, 2019
Accepted: August 20, 2019
Article in press: August 20, 2019
Published online: September 26, 2019
Processing time: 169 Days and 20 Hours
Abstract
BACKGROUND

Pancreaticoduodenal artery (PDA) aneurysms are extremely rare. The complicated clinical presentations and high incidence of rupture make it difficult to diagnose and treat. PDA pseudoaneurysms often rupture into the gastrointestinal tract and result in life-threatening gastrointestinal hemorrhage.

CASE SUMMARY

A 69-year-old man was admitted to our hospital due to right upward abdominal pain. A computed tomography (CT) scan demonstrated acute cholecystitis and cholecystolithiasis. Percutaneous gallbladder drainage was performed subsequently. He was discharged after 3 d and readmitted to hospital for cholecystectomy as arranged 1 mo later. A repeat CT scan revealed an emerging enhancing mass between the pancreatic head and the descending duodenum. Then, he suffered hematochezia and hemorrhagic shock suddenly. Emergency percutaneous angiogram was performed and selective catheterization of the superior mesenteric artery demonstrated a pseudoaneurysm in the inferior PDA. Coil embolization was performed and his clinical condition improved quickly after embolization and blood transfusion. He underwent laparoscopic cholecystectomy and was discharged from hospital after surgery under satisfactory conditions.

CONCLUSION

PDA pseudoaneurysms are uncommon. Acute haemorrhage is a severe complication of pseudoaneurysm with high mortality which clinicians should pay attention to.

Keywords: Calculous cholecystitis; Inferior pancreaticoduodenal artery pseudoaneurysm; Gastrointestinal haemorrhage; Coil embolization; Case report

Core tip: Pancreaticoduodenal artery (PDA) aneurysms are extremely rare, accounting for only 2% of all visceral artery aneurysms. PDA aneurysms are divided into pseudoaneurysms or true aneurysms. Pseudoaneurysms of the PDA that ruptured into the duodenum causing massive hemorrhage are rare and life-threatening. In this case, the patient was successfully treated with the accurate diagnosis and effective coil embolization. Clinicians should consider the possibility of ruptured pseudoaneurysms in patients with active gastrointestinal bleeding. The familiarity of this disease and appropriate treatments will save lives timely.