Spontaneous inferior pancreaticoduodenal artery pseudoaneurysm rupture

Abstract

A previously healthy 56-year-old woman presented to the emergency department with pre-syncopal symptoms that began while she was straining on the toilet. On arrival, the patient complained of a persistent, diffuse abdominal cramping like she ''needed to have a bowel movement.'' She was immediately placed on a monitor. The vitals were: blood pressure 80/50 mmHg, heart rate 60 beats/min, respiratory rate 12/min, oxygen saturation 99% on room air. The physical examination demonstrated a mildly tender epigastrium and brisk peripheral pulses.Bedside emergency ultrasound revealed free fluid in both the splenorenal and hepatorenal views. Two large bore intravenous lines were secured, massive transfusion protocol was initiated, and the patient received two units of O-negative blood. The surgical service was emergently consulted, and the patient was brought for a computed tomography abdomen and pelvis (Fig.

Rupture of an Idiopathic Aneurysm of the Inferior Pancreaticoduodenal Artery Leading to an Intra-Abdominal Bleeding

“…The occurrence of visceral artery aneurysms are rare, only appearing in 0.02%-0.1% of cases [5]. The prevalence of superior and inferior PDA aneurysms accounts for approximately 10% of all visceral artery aneurysms [4] .…”

Pseudoaneurysm of the Inferior Pancreaticoduodenal Artery Due to Cholecystitis

“…The most common causes of inferior pancreaticoduodenal pseudoaneurysms are iatrogenic or following trauma [1]. Approximately 30% of inferior pancreaticoduodenal pseudoaneurysms or aneurysms are due to pancreatitis.…”

“…Visceral artery aneurysms and pseudoaneurysms are a rare finding and has an estimated prevalence of 0.01% to 0.2% [1]. The incidence of pseudoaneurysms or aneurysms of the superior and inferior pancreaticoduodenal arteries has been reported as approximately 10% [2].…”

Pseudoaneurysm of the Pancreaticoduodenal Artery Associated with Duodenal Diverticulitis

“…Hemorrhage from the pancreaticoduodenal artery and its branches has been found after trauma and surgery and in patients with acute and chronic pancreatitis amongst other causes [11, 12]. Pseudoaneurysm formation may be observed, which represents a potentially life-threatening condition and warrants intervention.…”

“…Pseudoaneurysm formation may be observed, which represents a potentially life-threatening condition and warrants intervention. Surgery may be necessary in some cases; however, interventional radiology offers a less invasive approach [11]. It should be considered that inflow to the pancreaticoduodenal arterial arcade may be from the celiac trunk through common hepatic and gastroduodenal artery or through a branch of the superior mesenteric artery, and access to this vessel may be difficult.…”