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Case Reports
. 2023 Dec 1;62(23):3479-3482.
doi: 10.2169/internalmedicine.1278-22. Epub 2023 Apr 14.

Pancreaticoduodenal Artery Aneurysm Rupture Presenting as Duodenal Obstruction Successfully Treated with Early Transcatheter Arterial Embolization: A Case Report of Suspected Segmental Arterial Mediolysis

Tatsuhiko Ishihara  1 , Toru Matsui  1 , Tomoji Katoh  1 , Katsuya Kobayashi  1 , Kenichiro Sekigawa  1 , Takeo Suzuki  2 , Hiroshi Mitsui  1
Affiliations
Case Reports

Pancreaticoduodenal Artery Aneurysm Rupture Presenting as Duodenal Obstruction Successfully Treated with Early Transcatheter Arterial Embolization: A Case Report of Suspected Segmental Arterial Mediolysis

Tatsuhiko Ishihara et al. Intern Med. .

Abstract

Visceral aneurysms are a rare but important form of abdominal vascular disease. Rupture of the aneurysms leads to serious symptoms, such as acute abdomen or abdominal bleeding. However, duodenal obstruction due to arterial rupture of an aneurysm is very rare. We herein report a 50-year-old woman with suspected segmental arterial mediolysis (SAM) who was first diagnosed with acute abdomen and duodenal obstruction. Rupture of a pancreaticoduodenal artery aneurysm was confirmed, and she was treated with transcatheter arterial embolization. In cases of acute abdomen, SAM is a rare but important possibility to consider as a differential diagnosis.

Keywords: abdominal aneurysm; duodenal obstruction; segmental arterial mediolysis; transcatheter arterial embolization.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
(A) Contrast CT reveals distension of the stomach and proximal duodenum with wall thickening of the second to third portion of the duodenum after repeated vomiting. (B) Upper endoscopy shows stenosis in the second to third portion of the duodenum. No mucosal findings suggest extramural compression. (C) An aneurysm of the pancreaticoduodenal arcade (arrow) with hematoma is observed. No evident extravasation is seen this time. CT: computed tomography
Figure 2.
Figure 2.
(A) Selective angiography of the SMA shows an aneurysm derived from the posterior branch of the IPDA. (B) TAE with a metallic coil is performed successfully. IPDA: inferior pancreaticoduodenal artery, TAE: transcatheter arterial embolization, SMA: superior mesenteric artery
See this image and copyright information in PMC

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