Duodenal intramural hematoma resulting from a ruptured aneurysm of the anterior pancreaticoduodenal artery.

Abstract

This is a report of a 31-year-old male with a ruptured aneurysm of the anterior pancreaticoduodenal artery. The patient developed a sudden upper abdominal pain and consulted us when it became intolerable. No muscular defense or rebound tenderness was present at initial examination. Leucocytosis and mild liver dysfunction were the only abnormal findings on admission. Anemia developed on the second day, which suggested intraperitoneal hemorrhage. CT scans showed a periduodenal hematoma, stenosis of the duodenum and an intraperitoneal hematoma. Celiac angiography showed extravasation from an anterior pancreaticoduodenal artery aneurysm (8mm in diameter). Emergency operation was performed consisting of evacuation of the doudenal intramural , retroperitoneal and intraperitoneal hematomas, resection of the aneurysm and ligation of the gastroduodenal artery. The volume of bleeding was estimated to be 2,700cc. The postoperative course was uneventful. According to the literature, the prognosis of this disease is poor. If a suitable operation is performed with a precise diagnosis based on CT scanning and angiography, the prognosis can be improved. In dealing with patients who have an acute abdomen with shock, rupture of an aneurysm of the pancreaticoduodenal artery should be considered.