Case Report
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World J Gastroenterol. Dec 7, 2013; 19(45): 8435-8439
Published online Dec 7, 2013. doi: 10.3748/wjg.v19.i45.8435
Endovascular pseudoaneurysm repair after distal pancreatectomy with celiac axis resection
Tatsuaki Sumiyoshi, Yasuo Shima, Yoshihiro Noda, Shingo Hosoki, Yasuhiro Hata, Takehiro Okabayashi, Akihito Kozuki, Toshio Nakamura
Tatsuaki Sumiyoshi, Yasuo Shima, Takehiro Okabayashi, Akihito Kozuki, Toshio Nakamura, Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi city, Kochi 781-8555, Japan
Yoshihiro Noda, Yasuhiro Hata, Department of Radiology, Kochi Health Sciences Center, Kochi, Kochi 781-8555, Japan
Shingo Hosoki, Department of Cardiovascular Internal Medicine, Kochi Health Sciences Center, Kochi, Kochi 781-8555, Japan
Author contributions: Sumiyoshi T, Shima Y, Noda Y, Hosoki S, Hata Y, Okabayashi T, Kozuki A and Nakamura T wrote the paper.
Supported by The Kochi Organization for Medical Reformation and Renewal
Correspondence to: Tatsuaki Sumiyoshi, MD, Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125 Ike, Kochi city, Kochi 781-8555, Japan. tasu050520@yahoo.co.jp
Telephone: +81-88-8373000 Fax: +81-88-8376766
Received: March 8, 2013
Revised: April 19, 2013
Accepted: June 1, 2013
Published online: December 7, 2013
Abstract

Erosive hemorrhage due to pseudoaneurysm is one of the most life-threatening complications after pancreatectomy. Here, we report an extremely rare case of rupture of a pseudoaneurysm of the common hepatic artery (CHA) stump that developed after distal pancreatectomy with en block celiac axis resection (DP-CAR), and was successfully treated through covered stent placement. The patient is a 66-year-old woman who underwent DP-CAR after adjuvant chemoradiotherapy for locally advanced pancreatic body cancer. She developed an intra-abdominal abscess around the remnant pancreas head 31 d after the surgery, and computed tomography (CT) showed an occluded portal vein due to the spreading inflammation around the abscess. Her general condition improved after CT-guided drainage of the abscess. However, 19 d later, she presented with melena, and CT showed a pseudoaneurysm arising from the CHA stump. Because the CHA had been resected during the DP-CAR, this artery could not be used as the access route for endovascular treatment, and instead, we placed a covered stent via the inferior pancreaticoduodenal artery originating from the superior mesenteric artery. After stent placement, cessation of bleeding and anterograde hepatic artery flow were confirmed, and the patient recovered well without any further complications. CT angiography at the 6-mo follow-up indicated the patency of the covered stent with sustained hepatic artery flow. To our knowledge, this is the first reported case of endovascular repair of a pseudoaneurysm that developed after DP-CAR.

Keywords: Distal pancreatectomy, En block celiac axis resection, Pseudoaneurysm, Endovascular treatment, Covered stent

Core tip: Erosive hemorrhage due to pseudoaneurysm is one of the most life-threatening complications after pancreatectomy. Here, we report an extremely rare case of rupture of a pseudoaneurysm of the common hepatic artery stump that developed after distal pancreatectomy with en block celiac axis resection. The pseudoaneurysm was successfully treated through covered stent placement via the inferior pancreaticoduodenal artery.