RUPTURE OF A PANCREATICODUODENAL ARTERY ANEURYSM: A CASE REPORT AND REVIEW OF THE LITERATURE.

Abstract

Pancreaticoduodenal artery (PD A) aneurysms are rare, with a reported incidence of 2% among all splanchnic artery aneurysms. Most of these lesions are undetectable until symptoms of rupture occur. In similar cases (65%), PDA rupture is usually associated with a high mortality rate, with fatal bleeding into the retroperitoneal space, intraperitoneal cavity or gastrointestinal tract. Clinical picture without rupture also has been reported (35%) and is often associated with atypic abdominal signs and symptoms or diagnosed incidentally on radiology studies. The Authors report a case of octogenarian patient with ruptured PDA aneurysm and bleeding into the retroperitoneal space presenting with stable clinical condition. Surgical treatment was performed successfully after radiological diagnosis of retroperitoneal haematoma with good outcome. Patients presenting catastrophic clinical condition need rapid resuscitation and emergency laparotomy: control of the bleeding site may be successful and aetiologycal diagnosis delayed after perioperative angiography. Further laparotomy is mandatory for a definitive treatment such as PDA obliteration or resection. An alternative therapy is the transcatheter embolization. In patients with relatively stable condition, radiological study is stressed. Anyway, the aneurysm should be obliterated whenever possible to avoid rebleeding or local complications such as erosion of the neighboring structure. In conclusion, an appropriate and early treatment lead to a good outcomes.