A Severe Case of Bleeding from Duodenal Invasion Due to Co-Morbid IPMC with Arcuate Ligament Syndrome and IPDA Aneurysm

An 81-year-old man with a history of left hemiplegia due to a cerebral hemorrhage was admitted to a clinic because of tarry stools. Endoscopic findings revealed an ulcerative lesion with hemorrhage in the descending duodenum. The patient was transferred to our hospital for treatment. Because endosco...

Full description

Saved in:
Bibliographic Details
Published inGan to kagaku ryoho Vol. 50; no. 13; p. 1581
Main Authors Umeno, Hiroki, Matsui, Hiroto, Tokumitsu, Yukio, Shindo, Yoshitaro, Nakajima, Masao, Watanabe, Yusaku, Tomochika, Shinobu, Iida, Michihisa, Suzuki, Nobuaki, Takeda, Shigeru, Ioka, Tatsuya, Nagano, Hiroaki
Format Journal Article
LanguageJapanese
Published Japan 01.12.2023
Subjects
Aged, 80 and over
Aneurysm - complications
Aneurysm - surgery
Celiac Artery - surgery
Duodenum
Embolization, Therapeutic
Hemorrhage - therapy
Humans
Ligaments
Male
Mesenteric Artery, Superior
Pancreas
Syndrome
Online AccessGet more information

Cover

More Information
Summary:An 81-year-old man with a history of left hemiplegia due to a cerebral hemorrhage was admitted to a clinic because of tarry stools. Endoscopic findings revealed an ulcerative lesion with hemorrhage in the descending duodenum. The patient was transferred to our hospital for treatment. Because endoscopic hemostasis was impossible, interventional radiology(IVR) hemostasis was performed using coil embolization for the feeding artery. Simultaneously, angiography showed stenosis of the root of the celiac axis due to arch ligament syndrome and an aneurysm of the inferior pancreaticoduodenal artery (IPDA). Due to the risk of rebleeding, subtotal stomach-preserving pancreatoduodenectomy was performed after the patient's overall condition had stabilized. Despite dissecting the arcuate ligament, the hepatic artery flow did not improve. Hence, a direct arterial anastomosis between the middle colic artery and the gastroduodenal artery was performed. Furthermore, due to the proximity of the IPDA aneurysm to the superior mesenteric artery, IVR embolization for the IPDA aneurysm was performed on postoperative day 8, and he was transferred to a rehabilitation hospital on postoperative day 57. The pathological result was invasive intraductal papillary mucinous carcinoma(IPMC). The patient has been an outpatient with no recurrence 12 months postoperatively.
ISSN:0385-0684