A Ruptured Pseudoaneurysm of Pancreaticoduodenal Artery: A Case Report

Pancreaticoduodenal artery (PDA) pseudoaneurysm is a rare occurrence. The intricate clinical manifestations and frequent rupture present challenges in diagnosing and treating the condition.

A 56-year-old man was admitted to the emergency department (ED) with sudden, severe abdominal pain, dizziness, and a history of two fainting events on the same day at home. A decreased blood pressure of 75/60 mmHg was detected on arrival. He had a medical background characterized by a history of gastritis and peptic ulcer disease (PUD) with ongoing use of pantoprazole and sucralfate. A contrast-enhanced computed tomography (CT) scan revealed retroperitoneal hematoma and a saccular outpouching in the superior and inferior pancreaticoduodenal arcades, in favor of visceral aneurysm, probably with the origin of the PDA. The patient underwent a laparotomy. The ruptured pseudoaneurysm was ligated using 4.0 polypropylene threads, and a Jackson-Pratt drain was inserted. The patient's recovery following the surgery was uneventful, and he was discharged after 5 days without any issues.

This case highlights the importance of considering a ruptured PDA pseudoaneurysm, which should be evaluated in the differential diagnosis of abdominal discomfort and related symptoms, especially in patients with duodenal ulcers. The successful management of the condition is accomplished through suture ligation, and the diagnosis is effectively made through CT angiography.