Management of true aneurysms of the pancreaticoduodenal arteries.
- de Perrot M Clinic of Digestive Surgery, Department of Surgery, University Hospital of Geneva, Switzerland.
- Berney T
- Deléaval J
- Bühler L
- Mentha G
- Morel P
- 1999-03-17
Published in:
- Annals of surgery. - 1999
Aged
Aneurysm, Ruptured
Duodenum
Female
Follow-Up Studies
Humans
Male
Mesenteric Arteries
Middle Aged
Pancreas
English
OBJECTIVE
To review the authors' recent experience and that of the literature since 1973 and to provide management guidelines for true aneurysms of the pancreaticoduodenal arteries (PDA).
SUMMARY BACKGROUND DATA
True aneurysms of the PDA are rare, with a total of only 52 cases reported since 1973.
METHODS
Six patients were admitted to the authors' institution between 1985 and 1995 for rupture of a true aneurysm of the PDA. They were analyzed with regard to the mode of presentation, preoperative workup, management, and outcome.
RESULTS
All patients had severe epigastric pain from retroperitoneal hemorrhage. Computed tomography scanning and angiography were performed in all cases. Aneurysms ranged from 0.7 to 1.2 cm (median 0.9 cm). The celiac axis was stenotic or occluded in five cases. Three patients underwent emergency pancreatoduodenectomy. Two of them survived. In one case, section of the median arcuate ligament was associated with the procedure, and the patient died from an aortic dissection. Embolization was performed in the last three patients. The procedure was definitive in two cases. In one, hemorrhage recurred 8 days later and required surgical ligation of the bleeding artery.
CONCLUSIONS
The authors recommend rapid treatment of all true aneurysms of the PDA. Because most of these aneurysms result from a stenosis of the celiac axis, selective embolization may help to preserve patency of the PDA and should, therefore, be the primary therapeutic choice in ruptured aneurysms. Close follow-up is mandatory because of possible recurrent bleeding. Appropriate and expeditious management of true PDA aneurysms should help reduce the mortality rate.
To review the authors' recent experience and that of the literature since 1973 and to provide management guidelines for true aneurysms of the pancreaticoduodenal arteries (PDA).
SUMMARY BACKGROUND DATA
True aneurysms of the PDA are rare, with a total of only 52 cases reported since 1973.
METHODS
Six patients were admitted to the authors' institution between 1985 and 1995 for rupture of a true aneurysm of the PDA. They were analyzed with regard to the mode of presentation, preoperative workup, management, and outcome.
RESULTS
All patients had severe epigastric pain from retroperitoneal hemorrhage. Computed tomography scanning and angiography were performed in all cases. Aneurysms ranged from 0.7 to 1.2 cm (median 0.9 cm). The celiac axis was stenotic or occluded in five cases. Three patients underwent emergency pancreatoduodenectomy. Two of them survived. In one case, section of the median arcuate ligament was associated with the procedure, and the patient died from an aortic dissection. Embolization was performed in the last three patients. The procedure was definitive in two cases. In one, hemorrhage recurred 8 days later and required surgical ligation of the bleeding artery.
CONCLUSIONS
The authors recommend rapid treatment of all true aneurysms of the PDA. Because most of these aneurysms result from a stenosis of the celiac axis, selective embolization may help to preserve patency of the PDA and should, therefore, be the primary therapeutic choice in ruptured aneurysms. Close follow-up is mandatory because of possible recurrent bleeding. Appropriate and expeditious management of true PDA aneurysms should help reduce the mortality rate.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1097/00000658-199903000-00016
- PMID 10077055
- Persistent URL
- https://sonar.ch/global/documents/33083
Statistics
Document views: 47
File downloads:
- Full-text: 0