Damage control surgery in patient with delayed rupture of pseudoaneurysm after blunt abdominal trauma

Abstract

Delayed rupture of post-traumatic pseudoaneurysms of the visceral arteries, especially the pancreaticoduodenal artery, is uncommon. Here, we describe a 55-year-old man hemorrhaging from a pseudoaneurysm of the inferior pancreaticoduodenal artery (IPDA). Computed tomography of the abdomen showed active bleeding in the IPDA and large amounts of hemoperitoneum and hemoretroperitoneum. Selective mesenteric angiography showed that the pseudoaneurysm arose from the IPDA, and treatment by angioembolization failed because the involved artery was too tortuous to fit with a catheter. Damage control surgery with surgical ligation and pad packing was successfully performed. The patient had an uncomplicated postoperative course and was discharged 19 days after the operation. To our knowledge, this is the first report of ruptured pseudoaneurysm of an IPDA after blunt abdominal trauma from Korea.

Submucosal Duodenal Artery Pseudoaneurysm Causing Massive Gastrointestinal Hemorrhage: A Case Report

“…7 However, the exact number is difficult to account for because most patients are asymptomatic. 7 , 8 The diagnosis is on the rise due to incidental detection from increased use of advanced imaging techniques and iatrogenic causes from an increase in procedures that use instrumentation. 7 The most common artery involved is the splenic artery.…”

“…Less than 2% of all visceral aneurysms are comprised from pancreaticoduodenal artery. 8 Pseudoaneurysms have a high incidence of rupturing; thus, patients can present with signs of hemodynamic collapse from catastrophic GI bleed. 7 Mortality rate of pseudoaneurysm rupture into the GI tract ranges from 25–70%.…”

“…4 Hemostasis may not be achieved in ruptured pseudoaneurysms, in which case, surgery or an interventional radiology team may attempt to stop the bleed by surgically removing the problem area or by arterial embolization. 8 Studies have shown that surgical treatment of visceral pseudo-aneurysm is associated with higher mortality in comparison to treatment by embolization. 5 , 8 Balloon tamponade may be performed in the ED when endoscopic, surgical, or interventional radiology treatment modalities are not rapidly available for patients with life-threatening upper GI hemorrhages.…”

“… 8 Studies have shown that surgical treatment of visceral pseudo-aneurysm is associated with higher mortality in comparison to treatment by embolization. 5 , 8 Balloon tamponade may be performed in the ED when endoscopic, surgical, or interventional radiology treatment modalities are not rapidly available for patients with life-threatening upper GI hemorrhages. 5 This procedure is a temporary means of stabilization until more definitive therapy can be obtained.…”