Takemoto Hiroki, Asayama Naoki, Takeuchi Yukari, Ogawa Yutaro, Tamari Hirosato, Shigita Kenjiro, Aoyama Taiki, Fukumoto Akira, Mukai Shinichi, Nagata Shinji
Department of Gastroenterology, Hiroshima City Asa Citizens Hospital.
Department of Endoscopy, Hiroshima City Asa Citizens Hospital.
Nihon Shokakibyo Gakkai Zasshi. 2019;116(4):344-352. doi: 10.11405/nisshoshi.116.344.
A man in his 40s with no remarkable past medical history was referred to our hospital with acute exacerbation of nonspecific epigastric pain by another hospital on the morning of the day of presentation. Though vital signs were stable, tenderness and guarding were observed over the entire abdomen. Contrast-enhanced computed tomography (CT) revealed a giant retroperitoneal hematoma due to a ruptured aneurysm close to the superior mesenteric artery. Emergency angiography of the superior mesenteric artery detected a ruptured 2-mm pseudoaneurysm of the posterior superior pancreaticoduodenal artery, for which embolization was immediately performed. The postoperative course was good, with the patient complaining only of transient abdominal pain due to exclusion of the hematoma on hospital day 6. His clinical symptoms disappeared with conservative treatment, and the patient was discharged on hospital day 18. Complete occlusion of the aneurysm and reduction of the hematoma was confirmed on follow-up CT. Pancreaticoduodenal artery aneurysm is an uncommon visceral artery aneurysm, and ruptured aneurysms typically result in fatal hemorrhage and high mortality. We herein report a case of ruptured aneurysm of the posterior pancreaticoduodenal artery where emergency transcatheter arterial embolization was able to save the patient's life. We also review 116 cases of pancreaticoduodenal artery aneurysm reported in Japanese literature.
一名40多岁、既往无显著病史的男性患者，在就诊当天上午因上腹部非特异性疼痛急性加重被另一家医院转诊至我院。尽管生命体征稳定，但全腹均有压痛和肌紧张。增强计算机断层扫描（CT）显示，由于靠近肠系膜上动脉的动脉瘤破裂，形成了巨大的腹膜后血肿。肠系膜上动脉急诊血管造影发现胰十二指肠后上动脉有一个2毫米的假性动脉瘤破裂，遂立即进行了栓塞治疗。术后病程顺利，患者仅在术后第6天因血肿清除出现短暂腹痛。经保守治疗，其临床症状消失，患者于术后第18天出院。随访CT证实动脉瘤完全闭塞，血肿缩小。胰十二指肠动脉动脉瘤是一种罕见的内脏动脉动脉瘤，破裂的动脉瘤通常会导致致命性出血和高死亡率。我们在此报告一例胰十二指肠后动脉动脉瘤破裂病例，经急诊经导管动脉栓塞术成功挽救了患者生命。我们还回顾了日本文献中报道的116例胰十二指肠动脉动脉瘤病例。
