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Special Feature
Dec 2012

Image of the Month—Diagnosis

Author Affiliations
 

SECTION EDITOR: CARL E. BREDENBERG, MD

Arch Surg. 2012;147(12):1148. doi:10.1001/archsurg.2011.2032b

Our patient had life-threatening hemobilia due to a pseudoaneurysm caused by chronic pancreatitis. Enhanced CT demonstrated a small pseudoaneurysm at the anterosuperior pancreaticoduodenal artery adjoining the pancreas head (Figure 1C). As this lesion communicated with the common bile duct, it might have caused massive hemobilia, resulting in the patient's hemodynamic instability. Although his condition required emergent angiography with embolization, it was not possible because of an anomaly of the hepatic artery. Instead, he underwent emergent laparotomy. To control the massive hemobilia, we performed a pancreaticoduodenectomy. Fortunately, the patient had an uneventful postoperative course. Microscopic investigation of the resected specimen showed chronic alcoholic fibrous pancreatitis accompanied by microfistula formation between the common bile duct and bleeding pseudoaneurysm (Figure 2). This connection could have facilitated the massive hemobilia.

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