A case of pancreaticoduodenal artery aneurysm ruptured into the common bile duct

A case of hemobilia caused by a ruptured pancreaticoduodenal artery aneurysm (PDAA) is reported. The case was a 56-year-old man with a habit of heavy drinking and a history of chronic pancreatitis. He was initially admitted for acute cholecystitis with gallstones and underwent a laparoscopic cholecystectomy after medical treatments. The operative procedure was uneventful. On postoperative day 3, however, he suffered from acute pancreatitis. Medical treatments seemed to be effective, but he experienced sudden hematemesis on postoperative day 8. A gastrointestinal endoscopy revealed active bleeding from the papilla of Vater. Computed tomography showed an increased density in the common bile duct and swelling of the pancreatic head. An abdominal angiography demonstrated a pseudoaneurysm of the posterior superior pancreaticoduodenal artery and extravasation of the contrast medium at the site of the aneurysm. Under a diagnosis of PDAA ruptured into the common bile duct, embolization using micro-coils was performed and the bleeding was stopped. The patient improved after the embolization, and re-rupture did not occur thereafter. PDAA is a rare type of abdominal visceral artery aneurysm, and hemobilia caused by a ruptured PDAA is very rare. Eighty-two cases of previously reported PDAA are reviewed.