Inferior Pancreaticoduodenal Artery Pseudoaneurysm Causing Biliary Obstruction: A Case Report

• Type of Material: Article
• Authors: Patrick Meloy, Emory University; WILL LINDQUESTER, Emory University; Jeffrey Stebbins, Emory Healthcare; Elaine Bromberek, Emory University
• Language: English
• Date: 2024-03-26
• Publisher: Department of Emergency Medicine at UCI School of Medicine
• Publication Version: Final Published Version
• Copyright Statement: © 2024 Meloy et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.5811/cpcem.1598
• Title of Journal or Parent Work: Clinical Practice and Cases in Emergency Medicine.
• Volume: 8
• Issue: 2
• Start Page: 01
• End Page: 04
• Keywords: Interventional radiology; Visceral artery aneurysm; Biliary obstruction; Emergency medicine
• Research Categories: Health Sciences, Radiology; Health Sciences, Medicine and Surgery

Abstract

Introduction: 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. Case Report: 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. Conclusion: 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.