Ruptured Gastroduodenal Artery Pseudoaneurysm and Penetration of the Duodenum and Common Bile Duct Caused by Tumor Necrosis: A Case of Resected Pancreatic Head Cancer during Neoadjuvant Chemotherapy

We report a case of ruptured pseudoaneurysm and penetration of the duodenum and bile duct caused by tumor necrosis during neoadjuvant chemotherapy (NAC). A 70-year-old man was given a diagnosis of pancreatic head cancer. CT showed the involvement of superior mesenteric vein and bile duct. The gastroduodenal artery (GDA) running through the tumor narrowed irregularly. We started gemcitabine+nab-paclitaxel as NAC. The patient was seen at the hospital because of massive melena after one course. Transcatheter arterial embolization (TAE) was performed as ruptured GDA pseudoaneurysm was diagnosed. We planned for an operation 3 weeks later because he developed grade 3 neutropenia and thrombocytopenia, and his circulatory condition was stable. However, rebleeding occurred 2 weeks after TAE, and emergency pancreaticoduodenectomy was performed. Histopathological examination revealed tissue defect caused by tumor necrosis at the penetrated duodenum and bile duct. Hemorrhage in the GDA was observed in the necrotic tissue. TAE for ruptured pseudoaneurysm prior to surgery is effective to stabilize vital signs. Both the patient’s condition and chemotherapy-related adverse effects should be taken into consideration for cases of oncologic emergency operation during chemotherapy.