Spontaneous Rupture of the Pancreaticoduodenal Artery: Three Cases

Abstract

We report 3 cases of spontaneous rupture of pancreaticoduodenal arteries (PDA). In the first case, an aneurysm of the PDA was demonstrated with stenosis of the celiac trunk; in the second case occlusion of the hepatic artery was shown. In both cases, arterial pancreatic arcades were enlarged and blood flow was retrograde from the superior mesenteric artery. Local high intravascular pressure due to retrograde blood flow through the arterial pancreatic arcades was thought to be the cause of aneurysm development and arterial rupture which necessitated surgical intervention. The third patient presented with a mycotic aneurysm that could be treated by intra-arterial embolization. The characteristics of this rare affliction are discussed, as is the treatment which first entails percutaneous embolization.

Therapeutic options in pancreatic pseudoaneurysms

“…Most patients start with nonspecific epigastric pain, but some other cases include debut as upper gastrointestinal bleeding due to rupture into the duct of Wirsung (also known as hemosuccum) or a more dramatic approach as massive hemoperitoneum due to rupture to free cavity, as our first case was, a really dramatic episode indeed with very high postoperative mortality figures (1,(5)(6)(7)(8).…”

“…Surgery has been traditionally the treatment employed to solve this entity, however nowadays endovascular aneurysm embolization is the treatment chosen up to 80% of cases (5,9), with different techniques depending on the material used (6)(7)(8).…”

“…Surgery is often complex and difficult, owing to various circumstances, especially the presence of a large retroperitoneal hematoma and inflammatory component secondary to pancreatic process, its anatomical location and the presence of numerous collateral arteries (7,9,10).…”

Spontaneous Rupture of the Pancreaticoduodenal Artery Possibly Related to Prior Occlusion of the Common Hepatic Artery: Report of a Case

“…To the best of our knowledge, there have only been two reports of a true PDA aneurysm associated with occlusion of the common hepatic artery, including the present case. 9 It has been suggested that stenosis or occlusion of the celiac axis might be related to the development of true PDA aneurysms. 9 Celiac axis stenosis or occlusion leads to the modification of blood flow through the pancreatic arcades, which supply the hepatic and splenic arteries from the superior mesenteric artery.…”

“…9 It has been suggested that stenosis or occlusion of the celiac axis might be related to the development of true PDA aneurysms. 9 Celiac axis stenosis or occlusion leads to the modification of blood flow through the pancreatic arcades, which supply the hepatic and splenic arteries from the superior mesenteric artery. Thus, blood flow might increase in the PDA and cause dilatation of this vessel with the eventual development of an aneurysm.…”