ArticleInternational journal of surgery case reports2026
Endovascular management of a ruptured pancreaticoduodenal artery pseudoaneurysm using a stent-graft: a case report and literature review.
Article in International journal of surgery case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Pancreaticoduodenal artery (PDA) pseudoaneurysms are rare vascular complications, accounting for approximately 2% of all visceral artery aneurysms. They are often associated with chronic pancreatitis and have a high risk of rupture, which can be life-threatening. Case presentation: A 45-year-old male with a history of chronic alcoholic pancreatitis presented with recurrent epigastric pain radiating to the back, associated with anorexia and significant weight loss. He had undergone multiple prior endoscopies and biopsies without a definitive diagnosis. During endoscopy at our institution, a pulsatile submucosal mass in the duodenum was identified, prompting CT angiography, which revealed a pseudoaneurysm of the superior posterior PDA with an arteriovenous fistula. Shortly afterward, the patient developed massive gastrointestinal (GI) bleeding and hemodynamic instability. Emergency angiography was attempted; however, coil embolization failed due to intra-procedural rupture. A covered stent (CeloNova 4.0 mm × 23 mm) was deployed, successfully excluding the pseudoaneurysm and stabilizing the patient. Discussion: PDA pseudoaneurysms are diagnostically challenging and often missed on standard imaging and endoscopy. Our case demonstrates the importance of maintaining a high index of suspicion in patients with chronic pancreatitis and unexplained GI findings. Endovascular therapy is the preferred treatment, with coil embolization as the standard approach; however, in cases of rupture, arteriovenous fistula, or failed embolization, covered stent grafting is a life-saving alternative. Conclusion: This case highlights a rare presentation of a ruptured PDA pseudoaneurysm with an AV fistula, initially missed despite multiple prior evaluations, successfully managed with a covered stent following failed embolization. Prompt recognition and flexible endovascular techniques are critical in preventing mortality in such complex vascular emergencies.
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