Background
True aneurysms of the pancreaticoduodenal arteries (PDA) are rare, often ruptured,
and treated by operation with a high level of mortality. We review our experience
since 1994 and that of the literature in the past 20 years to provide management guidelines
for this uncommon clinical entity. About 100 cases of PDA aneurysms are described
in the literature, most of them as case report.
Methods
Nine patients were admitted to our institution between 1994 and 2004 for true aneurysm
of the PDA. They were analyzed with regard to the clinical presentation, radiologic
findings, management, and outcome.
Results
Seven patients presented for sudden abdominal pain from retroperitoneal hemorrhage.
In 2 patients PDA aneurysm was an incidental finding. Abdominal ultrasonography, computed
tomographic scan, and visceral angiography was carried out in all cases. Aneurysms
ranged from 4 to 30 mm (median, 16.5) in size. Celiac axis stenosis or occlusion was
identified in 3 patients. One patient required emergent laparotomy for intra-abdominal
rupture of a retro peritoneal hematoma. Therapeutic embolization was successful in
all 9 patients. All except 1 are alive with no evidence of recurrence of the true
PDA aneurysm with a mean follow-up of 59 months.
Conclusions
The authors recommend definitive treatment of all true aneurysms PDA because of their
high risk of rupture. Ruptured PDA aneurysms suspected on CT-scan requires emergent
visceral angiography and selective embolization as definitive treatment.
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Article info
Publication history
Accepted:
October 29,
2005
Identification
Copyright
© 2006 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
