Successful treatment of pseudoaneurysm rupture after pylorus preserving pancreaticoduodenectomy by covered stent placement.

Abstract Serious complications after pancreaticoduodenectomy (PD) include pseudoaneurysm formation andABSTRACT rupture accompanying pancreatic fistula, and pancreatojejunostomy leakage, which is commonly associated with mortality or liver failure. We report a case of the successful treatment of pseudoaneurysm rupture after pylorus-preserving pancreaticoduodenectomy (PPPD) by covered stent placement. A 70-year-old man underwent PPPD for ampullary carcinoma. After the procedure, a pancreatic fistula was detected, and suction drainage was continued. The patient was discharged on the twenty-first post-operative day. On the same day, arterial bleeding was detected from the pancreatojejunostomy drain, and emergency abdominal angiography showed a pseudoaneurysm of 3-cm diameter at the proper hepatic artery (PHA). Multiple embolization coils were placed in a pseudoaneurysm. However, bleeding still continued, so hemostasis with coils was considered unfeasible. The next strategy was to place a covered stent, but the PHA was thick; thus, a biliary covered stent was implanted. Angiographic examination subsequently revealed that hepatic arterial flow was maintained, and there were no aneurysms. However, a few days later, a coil that had migrated into a peripheral branch of the right hepatic artery caused multiple hepatic abscesses, and percutaneous transhepatic abscess drainage was performed before the patient was discharged. Although coils were initially sufficient for hemostasis, repeatedly recurrent bleeding led to the consideration of a covered stent.