| Pseudoaneurysmal rupture of the common hepatic artery into the biliodigestive anastomosis. A rare cause of gastrointestinal bleeding. | |
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MedLine Citation:
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PMID: 19581753 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Spiridon Vernadakis; Evangelos Christodoulou; Jürgen Treckmann; Fuat Saner; Andreas Paul; Zoltan Mathe |
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Publication Detail:
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Type: Case Reports; Journal Article Date: 2009-07-06 |
Journal Detail:
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Title: JOP : Journal of the pancreas Volume: 10 ISSN: 1590-8577 ISO Abbreviation: JOP Publication Date: 2009 |
Date Detail:
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Created Date: 2009-07-07 Completed Date: 2009-09-28 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101091810 Medline TA: JOP Country: Italy |
Other Details:
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Languages: eng Pagination: 441-4 Citation Subset: IM |
Affiliation:
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Department of General, Visceral and Transplantation Surgery, University Hospital, Essen, Germany. spiridon.vernadakis@uk-essen.de |
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| MeSH Terms | |
Descriptor/Qualifier:
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Anastomosis, Roux-en-Y Aneurysm, False / complications* Aneurysm, Ruptured / complications* Bile Ducts / surgery Female Gastrointestinal Hemorrhage / etiology*, prevention & control Hepatic Artery / pathology* Humans Intestinal Fistula / etiology, prevention & control Intestine, Small / surgery Middle Aged Pancreaticoduodenectomy / adverse effects Postoperative Complications |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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