Surgical management of peripancreatic arterial aneurysms

Abstract

Peripancreatic artery aneurysms--gastroduodenal (GDA) and pancreaticoduodenal (PDA)--are highly unusual. We report 4 such aneurysms and have collated reports of true peripancreatic artery aneurysms based on an extensive review of the English literature. From this review, patient characteristics, clinical behavior, outcome and management strategies are assessed.

Therapeutic angioembolization of bleeding pancreaticoduodenal artery pseudoaneurysm following laparoscopy assisted Frey's procedure

“…A pseudoaneurysm develops when the rupture is contained and the hematoma is surrounded by a reactive fibrous capsule. Gastroduodenal artery aneurysms are extremely rare, comprising only 1.5% of all reported peripheral aneurysms, with pancreatico duodenal artery pseudoaneurysms being much rarer [1,2,[6][7][8].…”

“…Early diagnosis of pseudoaneurysms is important because of the risk of rupture and subsequent mortality. There are multiple etiologies for the development of pseudoaneurysms including atherosclerosis, trauma, surgery, pancreatitis, infection, collagen vascular disease and congenital abnormalities [1,2,4,6]. Patients may be asymptomatic or present with symptoms of gastrointestinal bleeding, intraperitoneal hemorrhage, obstructive jaundice due to external pressure by the pseudoaneurysm or hemobilia [1,2,6,7].…”

Therapeutic options in pancreatic pseudoaneurysms

“…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).…”

“…As for the technique, control and vascular ligation of the aneurysm would be ideal, but on many occasions, we must resort to performing cephalic or distal pancreatectomy (8)(9)(10).…”