Obstructive Jaundice Caused by Pancreaticoduodenal Artery Aneurysms Associated with Celiac Axis Stenosis: Case Report and Review of the Literature

Yin, Tiansheng; Wan, Zhili; Chen, Hongwei; Mao, Xixian; Yi, Ya-Yang; Li, Dewei

doi:10.1016/j.avsg.2014.12.011

Cited by 4 publications

(5 citation statements)

References 25 publications

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“…[ 22 ] 2013 F 64 Intense acute abdominal pain, dilated intra- and extrahepatic biliary tracts (14 mm) Yes No isolated 2-cm true aneurysm origin from PDA Ultrasonography Contrast-enhanced CT scan Laparotomy TAE (injection of polymeric synthetic into the aneurysm) S 9 Yin et al . [ 11 ] 2014 M 84 RUQ pain, jaundice Yes Yes Retroperitoneal hematoma and 2 cm aneurysm origin from PDA Ultrasonography Abdominopelvic CT scan CT angiography Conventional angiography TAE (with no need to drain the liver) D 10 Otaegui et al . [ 23 ] 2016 M 48 Jaundice, epigastric pain, acholic stools, and dark-colored urine, dilated intra- and extrahepatic tracts Yes No 3.5 cm pseudoaneurysm origin from inferior PDA, which was anastomosed with the posterior PDA Ultrasonography Abdominopelvic CT scan TAE S 11 Current study 2022 F 77 Jaundice, abdominal pain, and abdominal distention Yes No 14 × 10 × 9 cm true aneurysm, 2.5 × 2.5 cm true aneurysm, and 1.5 × 1.2 cm true aneurysm origin from posterior side of PDA Ultrasonography Doppler ultrasound Abdominopelvic CT scan CT angiography Conventional angiography Laparotomy D PDAA pancreaticoduodenal artery aneurysm, PDA pancreaticoduodenal ...…”

Section: Discussionmentioning

confidence: 99%

“…Etiologies of PDAA are classified into two broad categories based on whether the aneurysm is true or pseudo. A pseudoaneurysm is usually caused by abdominal trauma or pancreatitis, but a true aneurysm is usually due to celiac axis stenosis [ 11 ]. Arterial atherosclerosis and MALS are two potential causes of celiac axis stenosis, which leads to PDAA [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…study, eight cases were mentioned that suffered from jaundice due to the compressive effect of PDAA; half of these cases expired, and five cases had ruptured aneurysms. Obstructive jaundice can be caused by the compression effect of the PDAA itself or retroperitoneal and peripancreatic hematoma associated with ruptured PDAA [ 11 ]. If this condition becomes chronic, it can subsequently cause secondary biliary cirrhosis, as in the current report which some radiologic signs of chronic parenchymal liver disease were present.…”

Section: Discussionmentioning

confidence: 99%

“…Yin et al . mentioned that endovascular therapy specific to PDAA usually resolves obstructive jaundice symptoms [ 11 ]. Otherwise, percutaneous transhepatic biliary drainage (PTBD) may be beneficial [ 54 , 55 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, due to the increased use of diagnostic modalities today, the rate of accidental diagnosis and reporting of asymptomatic PDAAs has increased [ 10 ]. Although, in scarce situations, mass-effect symptoms such as biliary obstruction [ 11 ], abdominal pain, abdominal distention, and spontaneous retroperitoneal hemorrhage [ 12 ] can be seen. When PDAA is ruptured, the mortality rate reaches 50%, even in asymptomatic cases [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Obstructive jaundice as a rare complication of multiple pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: a case report and review of the literature

Jalili,

Javadrashid,

Alvandfar

et al. 2023

J Med Case Reports

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Background Obstructive jaundice has various causes, and one of the rarest is pancreaticoduodenal artery aneurysm (PDAA), which is often associated with celiac axis stenosis caused by median arcuate ligament syndrome (MALS). Case presentation The patient was a 77-year-old Azeri woman who presented with progressive jaundice, vague abdominal pain, and abdominal distension from 6 months ago. The intra- and extrahepatic bile ducts were dilated, the liver's margin was slightly irregular, and the echogenicity of the liver was mildly heterogeneous in the initial ultrasound exam. A huge cystic mass with peripheral calcification and compressive effect on the common bile duct (CBD) was also seen near the pancreatic head, which was connected to the superior mesenteric artery (SMA) and had internal turbulent blood flow on color Doppler ultrasound. According to the computed tomography angiography (CTA) findings, the huge mass of the pancreatic head was diagnosed as a true aneurysm of the pancreaticoduodenal artery caused by MALS. Two similar smaller aneurysms were also present at the huge aneurysm's superior margin. Due to impending rupture signs in the huge aneurysm, the severe compression effect of this aneurysm on CBD, and the patient's family will surgery was chosen for the patient to resect the aneurysms, but unfortunately, the patient died on the first day after the operation due to hemorrhagic shock. Conclusion In unexpected obstructive jaundice due to a mass with vascular origin in the head of the pancreas, PDAA should be considered, and celiac trunk should be evaluated because the main reason for PDAA is celiac trunk stenosis or occlusion by atherosclerosis or MALS. The treatment method chosen (including transarterial embolization, open surgery, or combined method) depends on the patient's clinical status and radiological findings, but transarterial embolization would be safer and should be used as a first-line method.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Obstructive jaundice as a rare complication of multiple pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: a case report and review of the literature

Jalili,

Javadrashid,

Alvandfar

et al. 2023

J Med Case Reports

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Pseudoaneurysm of the gastroduodenal artery: an unusual cause for hyperamylasaemia

Galanakis¹

2018

BMJ Case Reports

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A 79-year-old man was admitted electively for investigation of weight loss. While he was an inpatient, he developed severe epigastric pain and an initial blood test revealed an acutely raised amylase (>2000) and deranged liver function tests. A contrast CT angiography showed a large haematoma adjacent to the duodenum, spreading in the retroperitoneal space, arising from a 2 cm bleeding pseudoaneurysm in the region of the gastroduodenal artery. Due to his underlying comorbidities, he was deemed unfit for surgical repair and he had coil embolisation with successful haemostasis. The gastroduodenal artery aneurysms are rare and constitute 1.5% of all visceral artery aneurysms. They can be an incidental finding or they can present with haemorrhagic shock, abdominal pain and rarely with obstructive jaundice or hyperamylasaemia. The diagnosis is usually made with an angiography. Variable treatment options are available depending on the patient's fitness and haemodynamic stability.

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Staged treatment for pancreaticoduodenal artery aneurysm with coeliac artery revascularisation: Case report and systematic review

et al. 2022

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Background Despite being rare, pancreaticoduodenal artery aneurysms (PDAAs) carry a risk of rupture of up to 50% and are frequently associated with coeliac artery occlusion. Methods PubMed and Embase databases were searched using appropriate terms. The systematic review was conducted according to PRISMA guidelines. Results We present the case of a 2 cm pancreaticoduodenal artery aneurysm pre-operative angiography demonstrated that the coeliac artery was occluded and the pancreaticoduodenal artery was providing collateral blood supply to the liver. Treatment was a staged hybrid intervention inclusive of an aorto-hepatic bypass using a 6 mm graft, followed by coil embolisation of the aneurysm. We also present a systematic review of the management of PDAAs. Two hundred and ninety-two publications were identified initially with 81 publications included in the final review. Of the 258 peripancreatic aneurysms included, 175 (61%) were associated with coeliac artery disease either occlusion or stenosis. Abdominal pain was the main presentation in 158 cases. Rupture occurred in 111 (40%) of patients with only ten (3.8%) cases being unstable on presentation. Fifty (18%) cases were detected incidentally while investigating another pathology. Over half the cases ( n=141/54.6%) were treated by trans arterial embolisation (TAE) alone, while 37 cases had open surgery only. Twenty-one cases needed TAE and a coeliac stent. Seventeen cases underwent hybrid treatment (open and endovascular). Sixteen cases were treated conservatively and in 26 cases, treatment was not specified. Conclusion PDAAs are commonly associated with coeliac artery disease. The most common presentation is pain followed by rupture. The scarcity of literature about true peripancreatic artery aneurysms associated with CA occlusive disease makes it difficult to assess the natural history or the appropriate treatment. Revascularisation of hepatic artery is better done with bypass in setting of median arcuate ligament compression and occluded celiac trunk.

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Obstructive Jaundice Caused by Pancreaticoduodenal Artery Aneurysms Associated with Celiac Axis Stenosis: Case Report and Review of the Literature

Cited by 4 publications

References 25 publications

Obstructive jaundice as a rare complication of multiple pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: a case report and review of the literature

Obstructive jaundice as a rare complication of multiple pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: a case report and review of the literature

Pseudoaneurysm of the gastroduodenal artery: an unusual cause for hyperamylasaemia

Staged treatment for pancreaticoduodenal artery aneurysm with coeliac artery revascularisation: Case report and systematic review

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