# Inferior Pancreaticoduodenal Artery Pseudoaneurysm Causing Biliary Obstruction: A Case Report

## TL;DR

A 64-year-old man with a history of chronic pancreatitis developed a rare pseudoaneurysm in the inferior pancreaticoduodenal artery, causing biliary obstruction and requiring emergency treatment.

## Contribution

This case highlights the rare but life-threatening complication of inferior pancreaticoduodenal artery pseudoaneurysm and its management in an emergency setting.

## Key findings

- A recurrent inferior pancreaticoduodenal pseudoaneurysm was diagnosed via contrast-enhanced CT in a patient with chronic pancreatitis.
- Emergency interventional radiology and biliary stenting successfully managed the pseudoaneurysm and obstructive cholangitis.
- The patient was discharged after resolution of pancreatitis and hyperbilirubinemia following treatment.

## Abstract

Visceral arterial aneurysms and pseudoaneurysms are rare but dangerous pathologies, with reported incidence of 0.01–0.2% of the worldwide population, as found on autopsy. Pancreaticoduodenal artery pathology accounts for approximately 2% of all visceral aneurysms; it is commonly caused by chronic inflammatory processes, such as pancreatitis or adjacent pseudocysts. Morbidity and mortality commonly result from rupture of the aneurysm itself, leading to life-threatening hemorrhage into the peritoneum or gastrointestinal tract.

Here we present the case of a 64-year-old male patient with previous history of alcohol use disorder leading to chronic pancreatitis and prior embolization of an inferior pancreaticoduodenal pseudoaneurysm, who presented to the emergency department (ED) with abdominal pain, nausea, and vomiting, and was found to have a large recurrent inferior pancreaticoduodenal pseudoaneurysm with associated obstructive cholangitis and pancreatitis via contrast-enhanced computed tomography (CT) of the abdomen and pelvis. The patient was managed emergently by interventional radiology angiography with embolic coiling and percutaneous biliary catheter placement, and he subsequently underwent biliary duct stenting with gastroenterology. The patient was successfully discharged after a brief hospitalization after resolution of his pancreatitis and associated hyperbilirubinemia.

Pancreaticoduodenal artery aneurysms and pseudoaneurysms are rare and dangerous visceral pathologies. Patients can be diagnosed rapidly in the ED with CT imaging and need urgent endovascular management to prevent morbidity and mortality.