Document Detail

Pseudoaneurysmal rupture of the common hepatic artery into the biliodigestive anastomosis. A rare cause of gastrointestinal bleeding.
MedLine Citation:
PMID:  19581753     Owner:  NLM     Status:  MEDLINE    
CONTEXT: Pseudoaneurysm of the hepatic artery after a pancreaticoduodenectomy is a serious complication, which should always be considered in the differential diagnosis when late bleeding has occurred. CASE REPORT: We report a case of pseudoaneurysmal rupture of the common hepatic artery into the biliodigestive anastomosis. A 55 year old female patient with a history of pancreatic head cancer underwent a pylorus preserving pancreaticoduodenectomy at our hospital in September 2008. Six days postoperatively the patient underwent surgery because of sentinel bleeding of a portal vein branch. On the 40th postoperative day she presented melena. Upper gastrointestinal endoscopy indicated bleeding near the biliodigestive anastomosis. An emergency angiography demonstrated a pseudoaneurysm of the common hepatic artery. Transcatheter arterial embolization was performed and a hemodynamic stabilization of the patient was achieved. Six days after the embolization the patient developed hemorrhagic shock and an urgent relaparotomy was carried out. The explorative laparotomy revealed bleeding of the common hepatic artery into the biliodigestive anastomosis in the form of an arteriointestinal fistula. The anastomosis was opened, the ruptured pseudoaneurysm was sutured, and a new biliodigestive anastomosis was made. The patient has been well for two months with good liver function, without rebleeding. CONCLUSION: This case illustrates the occurrence of a rare complication (rupture of a hepatic artery pseudoaneurysm) inside the biliodigestive anastomosis after pancreaticoduodenectomy, appearing as upper gastrointestinal bleeding. Different modalities such as transarterial embolization and the use of stents give promising results, but ligation of the pseudoaneurysm and repair of the intestinal communication is also an effective modality of treatment.
Spiridon Vernadakis; Evangelos Christodoulou; Jürgen Treckmann; Fuat Saner; Andreas Paul; Zoltan Mathe
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2009-07-06
Journal Detail:
Title:  JOP : Journal of the pancreas     Volume:  10     ISSN:  1590-8577     ISO Abbreviation:  JOP     Publication Date:  2009  
Date Detail:
Created Date:  2009-07-07     Completed Date:  2009-09-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101091810     Medline TA:  JOP     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  441-4     Citation Subset:  IM    
Department of General, Visceral and Transplantation Surgery, University Hospital, Essen, Germany.
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MeSH Terms
Anastomosis, Roux-en-Y
Aneurysm, False / complications*
Aneurysm, Ruptured / complications*
Bile Ducts / surgery
Gastrointestinal Hemorrhage / etiology*,  prevention & control
Hepatic Artery / pathology*
Intestinal Fistula / etiology,  prevention & control
Intestine, Small / surgery
Middle Aged
Pancreaticoduodenectomy / adverse effects
Postoperative Complications

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