Meloy Patrick, Lindquester Will S, Stebbins Jeffrey, Bromberek Elaine
Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia.
Clin Pract Cases Emerg Med. 2024 May;8(2):125-128. doi: 10.5811/cpcem.1598.
Visceral arterial aneurysms and pseudoaneurysms are rare but dangerous pathologies, with reported incidence of 0.01-0.2% of the worldwide population, as found on autopsy. Pancreaticoduodenal artery pathology accounts for approximately 2% of all visceral aneurysms; it is commonly caused by chronic inflammatory processes, such as pancreatitis or adjacent pseudocysts. Morbidity and mortality commonly result from rupture of the aneurysm itself, leading to life-threatening hemorrhage into the peritoneum or gastrointestinal tract.
Here we present the case of a 64-year-old male patient with previous history of alcohol use disorder leading to chronic pancreatitis and prior embolization of an inferior pancreaticoduodenal pseudoaneurysm, who presented to the emergency department (ED) with abdominal pain, nausea, and vomiting, and was found to have a large recurrent inferior pancreaticoduodenal pseudoaneurysm with associated obstructive cholangitis and pancreatitis via contrast-enhanced computed tomography (CT) of the abdomen and pelvis. The patient was managed emergently by interventional radiology angiography with embolic coiling and percutaneous biliary catheter placement, and he subsequently underwent biliary duct stenting with gastroenterology. The patient was successfully discharged after a brief hospitalization after resolution of his pancreatitis and associated hyperbilirubinemia.
Pancreaticoduodenal artery aneurysms and pseudoaneurysms are rare and dangerous visceral pathologies. Patients can be diagnosed rapidly in the ED with CT imaging and need urgent endovascular management to prevent morbidity and mortality.
内脏动脉瘤和假性动脉瘤虽罕见但危险，尸检发现其在全球人口中的发病率为0.01 - 0.2%。胰十二指肠动脉病变约占所有内脏动脉瘤的2%；其常见病因是慢性炎症过程，如胰腺炎或相邻假性囊肿。发病率和死亡率通常源于动脉瘤本身破裂，导致危及生命的腹腔或胃肠道出血。
我们在此报告一例64岁男性患者，有酒精使用障碍导致慢性胰腺炎病史，曾行胰十二指肠下假性动脉瘤栓塞术。该患者因腹痛、恶心和呕吐就诊于急诊科，经腹部和盆腔增强计算机断层扫描（CT）发现有一个巨大的复发性胰十二指肠下假性动脉瘤，并伴有阻塞性胆管炎和胰腺炎。患者通过介入放射学血管造影进行紧急处理，采用栓塞线圈和经皮胆道导管置入术，随后接受了胃肠病学的胆管支架置入术。患者在胰腺炎和相关高胆红素血症消退后短暂住院治疗后成功出院。
胰十二指肠动脉瘤和假性动脉瘤是罕见且危险的内脏病变。患者可在急诊科通过CT成像迅速诊断，需要紧急血管内治疗以预防发病和死亡。
