J Korean Soc Radiol.  2017 Nov;77(5):313-316. 10.3348/jksr.2017.77.5.313.

Percutaneous Transhepatic Embolization for Isolated Pancreaticoduodenal Vein Rupture in Blunt Abdominal Trauma: A Case Report

• Kwon H
• Kim CW
• Jeon CH
• Yeo KH
• Noh D
• Lee CK

• KMID: 2394045
• DOI: http://doi.org/10.3348/jksr.2017.77.5.313

Abstract

In blunt abdominal trauma, the prevalence of superior mesenteric vein injury or portal vein injury is low and surgical treatment is often difficult. We report a case of percutaneous transhepatic embolization in a patient who experienced isolated rupture of the pancreaticoduodenal vein (PDV). The patient sustained abdominal trauma in a motorcycle accident. A pseudoaneurysm was suspected in the anterior pancreatic head based on the portal venous phase of computed tomography. However, the lesion was not observed on celiac arteriography and superior mesenteric arteriography. PDV rupture was detected by additional percutaneous transhepatic superior mesenteric venography, and embolization was performed by trapping the PDV. This procedure is a safe, minimally invasive method that can be performed in patients with injuries of the portal venous system accompanying abdominal trauma; this procedure effectively reduces the need for invasive surgery.

MeSH Terms

Abdominal Injuries
Aneurysm, False
Angiography
Embolization, Therapeutic
Head
Humans
Mesenteric Veins
Methods
Motorcycles
Phlebography
Portal Vein
Prevalence
Rupture*
Veins*

Figure

• 

  Fig. 1 A 33-year-old male sustained injury in a motorcycle accident. CT revealed a pseudoaneurysm in the anterior pancreatic head. A, B. Axial contrast-enhanced CT image demonstrates hemoperitoneum in the perihepatic space and splenic hilum. C. The portal venous phase CT image demonstrates a lesion considered to be a pseudoaneurysm in the ventral pancreatic head (arrow). D. Selective pancreaticoduodenal venography demonstrates a ruptured venous pseudoaneurysm with contrast extravasation (arrow). E. Postembolization venography demonstrates complete exclusion of the pseudoaneurysm and successful filling of the superior mesenteric vein. F. Follow-up CT showing the coils in the completely excluded pseudoaneurysm and a patent superior mesenteric vein. CT = computed tomography

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