A Case of Ruptured Pancreaticoduodenal Artery Aneurysm with Portal Vein Obstruction Caused by Abdominal Hematoma and Abdominal Hematoma Causing Portal Vein Obstruction Treated by Combined Therapy

• Published in: Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 39; no. 7; pp. 1287 - 1291
• Main Authors: Eto, Ryotaro, Nojima, Hiroyuki, Takayashiki, Tsukasa, Takahashi, Makoto, Suzuki, Daisuke, Yoshitomi, Hideyuki, Ohtsuka, Masayuki
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society for Abdominal Emergency Medicine 30.11.2019; 日本腹部救急医学会
• Subjects: 腹腔内血腫; 腹腔動脈起始部圧迫症候群; 膵十二指腸動脈瘤; 門脈血栓
• ISSN: 1340-2242; 1882-4781
• DOI: 10.11231/jaem.39.1287

A 41-year-old man with abdominal pain was referred to our hospital and was diagnosed as having portal vein obstruction caused by extramural compression by an abdominal tumor. Despite the anticoagulant treatment that the patient was initiated on, blood tests revealed a continued fall of the hemoglobin level, and multidetector-row computed tomography (MDCT) showed an increase in the size of the abdominal tumor, a pancreaticoduodenal artery aneurysm, and celiac axis compression syndrome. Based on the findings, we diagnosed the patient as having a large hematoma and performed transcatheter arterial embolization for treating the pancreaticoduodenal artery aneurysm, and then, surgical removal of the abdominal hematoma and portal vein thrombus. The patient was discharged on day 40 after the initial surgery. Follow-up MDCT showed steady portal venous flow 2 years after the surgery. Portal vein obstruction caused by an abdominal hematoma resulting from pancreaticoduodenal artery aneurysm is extremely rare.