Pseudoaneurysm of the gastroduodenal artery following pancreatoduodenectomy. Stenting for hemorrhage

Abstract

Postpancreatectomy hemorrhage (PPH) and pancreatic fistula are main and serious complications following pancreaticoduodenectomy. Postpancreatectomy hemorrhage is considered life-threatening for its high rate of mortality. Postpancreatectomy hemorrhage is defined as early, occurring within 24 h after surgery, and late. The authors present a case of late PPH which developed in the third week following pylorus-preserving pancreaticoduodenectomy. A 58-year-old man was operated on for cancer of the pancreatic head. Hemorrhage occurred when the patient was in full health, convalescing at home. The cause was bleeding from a pseudoaneurysm of the stump of the gastroduodenal artery directly into the gastrointestinal tract. Diagnosis was established based on computed tomography angiography. Treatment was performed using minimally invasive technique during angiography. The implantation of a stent graft into the common hepatic artery for bridging the stump of the gastroduodenal artery was performed. This method thus enabled at once both diagnosis and successful minimally invasive treatment.

Keywords: hemorrhage; pancreaticoduodenectomy; pseudoaneurysm; stents.

Photo 1

PET-CT examination with a lesion in the head of the pancreas 33 mm × 26 mm × 29 mm accumulating 16-FDG

Photo 2

CT angiography – pseudoaneurysm of the stump of the gastroduodenal artery – volume rendering reconstruction

Photo 3

CT angiography – pseudoaneurysm of the stump of the gastroduodenal artery – coronal reconstruction

Photo 4

Arteriography of hepatic artery with implanted stent graft