Osaragi Kensuke, Matsumoto Tomohiro, Yoshimatsu Rika, Ichiki Junya, Osaki Marina, Hamada Ryo, Noda Yoshihiro, Yamagami Takuji
Department of Radiology, Kochi Health Sciences Center, Japan.
Department of Diagnostic and Interventional Radiology, Kochi University, Kochi Medical School, Japan.
Interv Radiol (Higashimatsuyama). 2024 Nov 22;10:e20240020. doi: 10.22575/interventionalradiology.2024-0020. eCollection 2025 Mar 28.
A 78-year-old man who had been treated for perihilar cholangiocarcinoma presented with hematemesis 1.5 years later. Computed tomography revealed a pseudoaneurysm of the proper hepatic artery protruding into the lumen of the duodenum. Esophagogastroduodenoscopy revealed a duodenal ulcer with massive hemorrhage at the duodenal bulb. Endoscopic hemostasis therapy was not possible due to the exposure of the proper hepatic artery pseudoaneurysm to the duodenal lumen. Endovascular stent-graft placement was chosen; the proper hepatic artery pseudoaneurysm disappeared and hematemesis was no longer observed. However, 2.5 years later, he presented with hematemesis, and esophagogastroduodenoscopy showed migration of the stent-graft into the duodenum due to duodenal ulcer recurrence.
一名曾接受肝门周围胆管癌治疗的78岁男性，1.5年后出现呕血症状。计算机断层扫描显示肝固有动脉假性动脉瘤突入十二指肠腔。食管胃十二指肠镜检查发现十二指肠球部有一个伴有大量出血的十二指肠溃疡。由于肝固有动脉假性动脉瘤暴露于十二指肠腔内，无法进行内镜止血治疗。于是选择了血管内支架植入术；肝固有动脉假性动脉瘤消失，未再观察到呕血现象。然而，2.5年后，他再次出现呕血症状，食管胃十二指肠镜检查显示由于十二指肠溃疡复发，支架移植物移入十二指肠。
