Ruptured small pancreaticoduodenal artery aneurysm-clinical features similar to pancreatitis: A case report

Pancreaticoduodenal artery aneurysm (PDAA) is rare and has high rupture risks. PDAA rupture has a wide range of clinical symptoms, including abdominal pain, nausea, syncope, and hemorrhagic shock, which is difficult to differentiate from other diseases. PATIENT CONCERNS: A 55-year-old female patient was admitted to our hospital due to abdominal pain for 11 days. DIAGNOSIS: Acute pancreatitis was initially diagnosed. The patient’s hemoglobin decreased compared to before admission, suggesting that active bleeding may occur. CT volume diagram and maximum intensity projection diagram show that a small aneurysm with a diameter of about 6 mm can be seen at the pancreaticoduodenal artery arch. The patient was diagnosed with a rupture and hemorrhage of the small pancreaticoduodenal aneurysm. INTERVENTIONS: Interventional treatment was performed. After the microcatheter was selected for the branch of the diseased artery for angiography, the pseudoaneurysm was displayed and embolized. OUTCOMES: The angiography showed that the pseudoaneurysm was occluded, and the distal cavity was not redeveloped. CONCLUSION: The clinical manifestations of PDAA rupture were significantly correlated with the aneurysm diameter. Because of small aneurysms, the bleeding is limited around the peripancreatic and duodenal horizontal segments, accompanied by abdominal pain, vomiting, and elevated serum amylase, similar to the clinical manifestations of acute pancreatitis but accompanied by the decrease of hemoglobin. This will help us to improve our understanding of the disease, avoid misdiagnosis, and provide the basis for clinical treatment.