s / Pancreatology 15 (2015) e1ee17 e9 Clinical case: Pancreatoduodenectomy was performed in a 64-year-old female with the diagnosis of neuroendocrine tumor at the head of the pancreas. There were no intraoperative nor immediate postoperative complications. On the 14th postoperative day a CT scan was carried out due to fever revealing a subphrenic and paracolic collectionwhichwas drained by a percutaneous catheter. Ten days later there was a sudden drop of haemoglobin (7.2 g/dL) and haematocrit (23%), but without haemodynamic instability. Three red cell concentrateswere transfused and a CTscan revealed a 22 pseudoaneurysm of the SMA. Immediate arteriography was performed and thrombin embolization of the pseudoaneurysm and stenting of the SMAwas carried out. After an uneventful recovery the patientwas discharged (VIDEO). Discussion: Pseudoaneurysms after pancreatic surgery develop between days 7th and 13th. Risk factors are pancreatic fistula, enteropancreatic leak and abdominal abscesses. Pancreatic enzymes or local septic conditions have been associated to vessel erosion and pseudoanerysm formation. Gastroduodenal artery stump is the most frequent localization, but hepatic, superior mesenteric or splenic artery can also be affected. When this complication is suspected an urgent CT scan should be performed. Once the presence of the pseudoaneurysm is confirmed, arteriography and embolization or the placement of stents is the method of choice depending upon the patient conditions and availability of the radiology interventional team. Transarterial embolization or stent placement is the most effective method with a successful rate higher than 80 % and a very low mortality (1%). Conclusion: Endovascular approach is a feasible and useful treatment for the management of pseudoaneurysms developed after pancreatic surgery.
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