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A Journal on Surgery

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Chirurgia 2000 October-December;13(5-6):303-6


language: English

Aneurysm of the inferior pancreaticoduodenal artery fistulized into the duct of Wirsung and in the inferior vena cava. Case report

Caratozzolo E., Recordare A., Massani M., Antoniutti M., Basso S., Bassi N.


Aneurysms of the visceral arteries are rare conditions with an incidence between 0.01% and 0.02%, representing 2% of all aneurysms. However, their clinical importance is related to the frequent complication in rupture, carrying a high mortality rate. Early diagnosis is therefore needed, but it is difficult, due to non-specific clinical symptoms. The recent spread of diagnostic methods such as CT, MR and especially angiography has meant that this pathology is more frequently encountered; consequently the number of cases treated by elective surgery has increased. Causes of morbidity and mortality are the difficult surgical access to these lesions and complications often associated with hemorrhage, such as lesions of neighbouring organs. Fistulization is not so unusual, due to the decubitus of the vascular wall on the parenchymatous, visceral and vascular organs related thereto. Fistulas are then described with the alimentary tract, the Wirsung duct and the extrahepatic bile ducts. This paper describes the multidisciplinary management and treatment of a case of aneurysm of the inferior pancreaticoduodenal artery in rupture, fistulized in the duct of Wirsung and in the inferior vena cava. In the reported case the combined surgical, radiological and endoscopic approach proved to be fundamental in the treatment of the aneurysmal lesion and its complications. The correct integration of these methods avoided a complex and widely destructive surgical procedure.

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