Pseudoaneurysm after pancreas resection poses serious complications, including rupture and hemorrhage. Here we report a case
of delayed massive hemorrhage from celiac and superior mesenteric arteries, which was successfully treated with a combined
endovascular and surgical approach. The patient was a 52-year-old man who presented with pseudoaneurysms of the celiac and
superior mesenteric arteries after distal pancreatectomy. Following the detection of sentinel bleeding from the abdominal
drain, emergency angiography of the celiac and superior mesenteric arteries revealed stenosis of the celiac artery and pseudoaneurysms
in the superior mesenteric artery. We occluded these lesions with a platinum coil, using an interventional radiological technique
combined with bypass grafting between the abdominal aorta and the SMA, using the saphenous vein. However, re-bleeding into
the abdominal cavity occurred from the proximal SMA pseudoaneurysm. We inserted an endoluminal stent-graft into the abdominal
aorta and completed bypass grafting between the aorta and bilateral renal arteries. The hemorrhage ceased and the postoperative
course was uneventful. The patient was discharged 34 days after the treatment (149 days after the initial operation). In conclusion,
this combined endovascular and surgical approach is feasible and seems appropriate for pseudoaneurysms arising from proximal
sites in visceral arteries.
Key words Distal pancreatectomy - Pseudoaneurysm - Superior mesenteric artery