Emergency Pancreaticoduodenectomy for Bleeding Pancreatic Pseudoaneurysm in Patient with Common Mesentery and Replaced Right Hepatic Artery
C. Lupaşcu, C. Ursulescu, D. AndronicImage Quiz for surgeons, no. 6, 2013
Pancreaticoduodenectomy is infrequently performed inemergency, so much the less in lack of traumatic evidence.A rare vascular complication of the pancreatic pseudocyst,the pseudoaneurysm, presents as a pulsating malformationwhich may lead to life-threatening bleeding if left untreated.Its optimal treatment remains controversial. Most authorsagree that angioembolization is the first step to stabilize thepatient’s condition, with further surgery if such be the case.We herein report an unusual case of pancreatic head pseudocystcomplicated with a bleeding pseudoaneurysm arisingfrom the inferior pancreaticoduodenal artery, in a patientwith multiple comorbid conditions, common mesentery,hepatic artery variant and hemodynamic instability. Anemergency early retropancreatic approach pancreaticoduodenectomywas performed with uneventful immediateand long-term outcome. We highlight that emergency surgeryallowed both rapid control over the bleeding with hemostasisand removal of the pseudocyst. This is particularly relevant inhigh-risk patients in whom selective angioembolization is nomore of choice.
