SA case of bowel perforation after arterial embolization for pancreaticoduodenal artery aneurysm

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  • A case of bowel perforation after arterial embolization for pancreaticoduodenal artery aneurysm

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An 80-year-old man was treated at another hospital for sudden abdominal pain. Plain computed tomography (CT) suggested the presence of an upper abdominal retroperitoneal hematoma. During examination, abdominal distention and hypotension between 70 and 79 mmHg occurred, then the patient fell into shock. He was emergently referred to our hospital. Immediately, abdominal contrast-enhanced CT was performed, revealing a ruptured pancreaticoduodenal artery aneurysm, and selected interventional radiology (IVR) was performed. A 1-cm aneurysm was identified in the posteroinferior pancreaticoduodenal artery, and arterial embolization was performed by injecting N-butyl-2-cyanoacrylate (Histoacryl) and fatty acid ethyl esters of iodized poppy seed oil (Lipiodol) into the first jejunal artery, through which the catheter tip had been successfully advanced. On the sixth day after arterial embolization, bleeding occurred from multiple ulcers that had presumably formed due to bowel ischemia. The ulcers penetrated the hematoma, but subsided after conservative treatment. The number of patients who undergo emergency IVR for such hemorrhagic lesions has increased, which highlights the importance of thoroughly understanding their diagnosis, treatment, and complications. In addition, because advances in IVR technology now allow access to aneurysms of relatively peripheral arteries, a comprehensive knowledge of embolic materials is critical.

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