Endovascular embolization of inferior pancreaticoduodenal artery pseudoaneurysm post-laparoscopic cholecystectomy in a patient with celiac artery stenosis – A case report

Abstract

Inferior pancreaticoduodenal artery (iPDA) pseudoaneurysms are mostly secondary to pancreatitis, abdominal trauma, or iatrogenic procedures. We present a rare case of iPDA pseudoaneurysm secondary to laparoscopic cholecystectomy in a patient with celiac artery stenosis. A 50-year-old man who underwent laparoscopic cholecystectomy 7 days back presented with abdominal pain, blood in drain output, and tachycardia. Abdominal computed tomography (CT) showed a large retroperitoneal hematoma adjacent to head of pancreas with a pseudoaneurysm likely arising from gastroduodenal artery. Proximal stenosis of celiac artery was also present. Digital subtraction angiography (DSA) showed pseudoaneurysm arising from posterior branch of iPDA. Coil embolization was performed with complete obliteration of the aneurysm. However, the patient presented again with increasing abdominal pain and hemoglobin drop after 8 days. CT showed migration of coil loop into the hematoma and residual filling of pseudoaneurysm. Repeat embolization was planned and the pseudoaneurysm with iPDA branch was embolized with 33% glue-lipoidal mixture. On follow-up 3 months later, the patient was found to be stable with no further complications. iPDA pseudoaneurysm is less commonly encountered visceral artery pseudoaneurysm. Trapping of pseudoaneurysm with both proximal and distal vessel occlusion is ideal method for embolization to prevent recurrence.