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Two synchronous pseudoaneurysms after bile duct resection for distal cholangiocarcinoma

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Abstract

Pseudoaneurysm is a potentially life-threatening complication after hepatobiliary pancreatic surgery. Although various measures have been taken to prevent the formation of postoperative pseudoaneurysms, completely avoiding complications can be difficult. An 83-year-old man underwent bile duct resection and systematic regional lymphadenectomies for distal cholangiocarcinoma. Polyethylene glycolic acid mesh with fibrin glue was applied to the pancreas around the distal stump and detached artery to prevent leakage of pancreatic juice and reinforce the arterial wall. Screening contrast-enhanced computed tomography on the 7th postoperative day indicated no pseudoaneurysm. The patient was discharged on the 20th postoperative day after an uneventful course. However, 4 days later, the patient visited the emergency outpatient department with a complaint of fever. Contrast-enhanced computed tomography revealed an abscess formation and a pseudoaneurysm around it. Emergency celiac arteriography revealed two pseudoaneurysms at the left hepatic artery and posterior superior pancreaticoduodenal artery; they were successfully treated with transcatheter arterial embolization using microcoils and covered stent placement. The patient was discharged 9 days after interventional radiology treatment. At the 14 months postoperative follow-up, the patient had no recurrence or stent obstruction. Multiple synchronous pseudoaneurysms are rare; accurately identifying the site by angiography and selecting appropriate treatment for each site is important.

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Acknowledgements

We would like to thank Editage (www.editage.jp) for English language editing.

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None of the authors have any funding sources to disclose.

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Authors and Affiliations

  1. Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama, Tokyo, 206-8512, Japan

    Hideyuki Takata, Atsushi Hirakata, Hiroshi Makino, Tadashi Yokoyama & Hiroyasu Furuki

  2. Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugi-machi, Nakahara-ku, Kawasaki-Shi, Kanagawa, 211-8533, Japan

    Hideyuki Takata, Satoshi Mizutani, Akira Katsuno & Nobuhiko Taniai

  3. Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Hiroshi Yoshida

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  1. Hideyuki Takata
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Correspondence to Hideyuki Takata.

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Takata, H., Hirakata, A., Makino, H. et al. Two synchronous pseudoaneurysms after bile duct resection for distal cholangiocarcinoma. Clin J Gastroenterol 15, 1151–1157 (2022). https://doi.org/10.1007/s12328-022-01711-8

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  • DOI: https://doi.org/10.1007/s12328-022-01711-8

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