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Pancreaticoduodenal artery aneurysm associated with polyarteritis nodosa presenting as massive upper gastrointestinal bleeding
  1. Juan Carlos Reyes Abon,
  2. Marc Paul Jose Lopez,
  3. A'Ericson Berberabe and
  4. Kenan Jared Cinco
  1. Department of Surgery, University of the Philippines Manila, Manila, Philippines
  1. Correspondence to Dr Juan Carlos Reyes Abon; carlos.abon{at}yahoo.com

Abstract

The pancreaticoduodenal arteries are rare sites for true aneurysm formation, but these may develop in association with occlusion of the coeliac circulation, degenerative conditions or inflammatory vascular disorders. These have a high risk of rupture regardless of size or other factors. One identified cause is polyarteritis nodosa (PAN), which is an autoimmune necrotising vascular condition that affects small-sized and medium-sized arteries. We report a case of a 40-year-old man with massive gastrointestinal tract bleeding from a ruptured pancreaticoduodenal artery aneurysm secondary to PAN. This was managed with emergent open aneurysm ligation followed by high-dose corticosteroids and cyclophosphamide pulse therapy. Only three other cases of PAN-associated pancreaticoduodenal artery aneurysms have been reported in the literature.

  • gastrointestinal surgery
  • vasculitis
  • GI bleeding

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Footnotes

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Contributors JCRA planned the report, collected clinical information and references, wrote the summary, background and discussion of the manuscript, and finalised the manuscript for submission. MPJL planned the report, edited the initial drafts of the manuscript and gave approval for the final manuscript. AEB edited the initial drafts and gave approval for the final manuscript. KJC collected clinical information and references, wrote the case presentation, and helped finalise the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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