Successful Management of Ruptured Pseudoaneurysm of Superior Mesenteric Artery (SMA) after Pancreatoduodenectomy by SMA-iliac Artery Bypass Grafting; Report of A Case

Hideyo Mukubou, Ippei Matsumoto, Sachiyo Shirakawa, Hirochika Toyama, Makoto Shinzeki, Toshiaki Tsujimura, Tetsuo Ajiki, Yuichi Hori, Takumi Fukumoto and Yonson Ku

Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine

Aggressive surgery should be considered when interventional radiology (IVR) is difficult in postpancreatectomic pseudoaneurysm. A 61-year-old man undergoing pancreatoduodenectomy for pancreatic-head cancer suffered massive hemorrhaging through an abdominal drainage tube due to postoperative pancreatic fistula and circulatory shock on postoperative day (POD) 10. Emergency abdominal superior mesenteric artery (SMA) angiography showed a pseudoaneurysm 10 mm in diameter at the SMA root. IVR hemostasis was technically difficult, so we conducted emergency laparotomy, ligating and suturing the SMA and conducting right common iliac artery-SMA bypass using a left great saphenous vein graft following remnant total pancreatectomy. The man recovered from shock and CT on POD 21 confirmed intestinal blood flow to be supplied by the iliac artery alone via the graft.

Key words
pseudoaneurysm, pancreatoduodenectomy, SMA bypass

Reprint requests
Hideyo Mukubou Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine
7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JAPAN

Accepted
October 28, 2009

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