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World J Gastrointest Surg. 2010 Sep 27;2(9):295-8. doi: 10.4240/wjgs.v2.i9.295.

Successful embolization assisted by covered stents for a pseudoaneurysm following pancreatic surgery.

World journal of gastrointestinal surgery

Koji Tanaka, Hiroaki Ohigashi, Hidenori Takahashi, Kunihito Gotoh, Terumasa Yamada, Isao Miyashiro, Masahiko Yano, Osamu Ishikawa

Affiliations

  1. Koji Tanaka, Hiroaki Ohigashi, Hidenori Takahashi, Kunihito Gotoh, Terumasa Yamada, Isao Miyashiro, Masahiko Yano, Osamu Ishikawa, Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases,1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan.

PMID: 21160899 PMCID: PMC2999694 DOI: 10.4240/wjgs.v2.i9.295

Abstract

Delayed intra-abdominal hemorrhage after pancreatic surgery is a potentially lethal complication. Transarterial coil embolization and/or the placing of an endovascular stent are minimally invasive and effective procedures. An artery that is extensively eroded and rendered friable due to operative skeletonization or postoperative inflammation sometimes contributes to delayed intra-abdominal hemorrhage or rebleeding after coil embolization. This report presents a case of successful management of postoperative hemorrhage in a-74-year-old Japanese male. He experienced bleeding from a pseudoaneurysm of the brittle hepatic artery following total pancreatectomy. Initially the pseudoaneurysm was successfully treated with covered coronary stent-grafts, but rebleeding occurred 1 mo later due to the brittleness of the artery. Rebleeding was definitively managed by the complete packing of the stent by coil embolization. He remains stable at 18 mo following the final embolization. A stent graft can be used for protecting a brittle artery to avoid injury by coil embolization.

Keywords: Covered stent; Hemorrhage; Hepatic artery; Pancreatic surgery; Pseudoaneurysm

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