Late Postduodenopancreatectomy Hemorrhage of Unusual Origin (Dorsal Pancreatic Artery): A Case Report

The late form of postpancreatectomy hemorrhage is suspected of a multifactorial pathogenesis, and presents a diagnostic and therapeutic challenge for practitioners, all the more so when it concerns an unusual origin, such as the dorsal pancreatic artery, of which the Anatomy is rich in variability. Diagnostic angiography or computed tomography have a higher sensitivity and CT angiography remains more informative. Transarterial embolization (TAE) appears to be associated with lower mortality compared to relaparotomy and endoscopy as first intervention for postpancreatectomy hemorrhage. But in case of bleeding from the dorsal pancreatic artery, embolization may be difficult due to the difficulty of its identification on angiography, especially during bleeding intervals, difficulties in superselection, and also due to the rich collateral circulation, which would increase the chances of technical problems and/or clinical failures. In this article we report the case of a 50-year-old patient treated for hemorrhagic shock following late surgery following a duodenopancreatectomy for adenocarcinoma of the head of the pancreas, due to a pseudoaneurysm of the dorsal pancreatic artery.