多发性胰十二指肠下动脉瘤破裂致十二指肠梗阻：介入栓塞治疗一例

doi:10.3877/cma.j.issn.2095-5782.2026.03.016

胰十二指肠下动脉瘤（inferior pancreaticoduodenal artery aneurysm，IPDAA）较为罕见，临床表现多样。本文报告一例于西北大学附属医院（西安市第三医院）就诊的59岁男性患者，以肠梗阻为首发症状，因血红蛋白进行性下降行增强CT检查，发现胰十二指肠下动脉多发动脉瘤并破裂，形成腹腔血肿压迫十二指肠，从而导致机械性梗阻。经导管动脉栓塞术成功栓塞动脉瘤后，患者肠梗阻症状逐渐缓解，复查影像显示血肿明显吸收、十二指肠水肿减轻。该病例提示，IPDAA可罕见地以肠梗阻作为首发表现。

关键词: 十二指肠梗阻, 胰十二指肠下动脉, 内脏动脉瘤, 经导管动脉栓塞术

Inferior pancreaticoduodenal artery aneurysms (IPDAA) are rare visceral aneurysms with diverse clinical presentations. We report the case of a 59-year-old man who initially presented with symptoms of intestinal obstruction, with imaging findings suggestive of duodenal stenosis. A subsequent progressive decrease in hemoglobin level prompted further evaluation with contrast-enhanced computed tomography, which revealed multiple ruptured IPDAAs associated with an abdominal hematoma compressing the duodenum and resulting in mechanical obstruction. The aneurysms were successfully treated with transcatheter arterial embolization. After the procedure, the patient's obstructive symptoms resolved, and follow-up imaging demonstrated gradual hematoma absorption and resolution of duodenal edema. This case highlights that IPDAA may present atypically as duodenal obstruction.

Key words: Duodenal obstruction, Inferior pancreaticoduodenal artery, Visceral aneurysms, Transcatheter arterial embolization

图1 患者入院时腹部增强CT及胃镜检查影像图图1A：全腹部增强CT显示示十二指肠降部及水平部弥漫性增厚，同胰腺组织分界不清，大小6 cm×10 cm，不均匀高密度多发条状影，无明显强化（箭头所指）；图1B：胃镜检查显示十二指肠降部因外部压迫而出现管腔狭窄，未见粘膜病变。

图2 患者复查腹部增强CT影像图图2A、2B：腹部增强CT横断位及3D重建示胰十二指肠多发动脉瘤形成，最大直径约2.7 cm；图2C、2D：冠状位示十二指肠降部絮状渗出较前增多,大小约8 cm×12 cm。

图3 经导管动脉栓塞术前造影图图3 A：腹腔干造影示胰十二指肠下动脉显影，可疑动脉瘤形成；图3B：肠系膜上动脉造影示胰十二指肠下动脉多发囊状动脉瘤（箭头）,最大约2.7 cm，见胃十二指肠动脉及肝固有动脉及分支显影。

图4 经导管动脉栓塞术中造影图图4A：微导管超选至载瘤动脉流出道；图4B：流出道及远端瘤体置入弹簧圈后，造影流出道及远端动脉瘤未见显影；图4C：微导管超选至瘤体，置入弹簧圈栓塞瘤体及流入道；肠系膜上动脉造影示胰十二指肠下多发动脉瘤未见显影；图4D：腹腔干造影示胰十二指肠下动脉瘤未见显影。

图5 患者术后随访复查CT影像图图5A：术后6天复查CT提示十二指肠周围渗出明显吸收（箭头），十二指肠降部仍水肿、囊袋样扩张；图5B：术后6月复查CT十二指肠降部肿胀消退（箭头），血肿吸收。

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Rupture of Multiple Lower Pancreaticoduodenal Artery Aneurysms Leading to Duodenal Obstruction: A Case of Interventional Embolization

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Rupture of Multiple Lower Pancreaticoduodenal Artery Aneurysms Leading to Duodenal Obstruction: A Case of Interventional Embolization