背景技术当60多岁的人经历腹痛时,呕吐,没有腹部手术史的原因不明的体重减轻,通常的诊断是由肿瘤引起的梗阻。然而,在非常罕见的情况下,这些症状起因于与内脏动脉瘤相关的并发症。案例报告我们介绍了一例60岁的男性,患有免疫缺陷和Sneddon-Wilkinson病(一种罕见的角膜下脓疱性皮肤病),他发展了一个起源不确定的胰十二指肠动脉瘤,与胰腺肿块有关,腹膜后血肿,和十二指肠梗阻.治疗方法包括经导管动脉线圈栓塞与支持措施,如肠外营养,鼻胃管,奥曲肽给药,和止吐药。尽管有这些干预措施,持续的胃肠道症状促使内镜超声细针抽吸术排除恶性肿瘤.活检证实局部纤维炎症。尽管他最初被认为是胃空肠旁路手术,保守治疗可有效改善胰腺病变和十二指肠梗阻,导致肠外营养中断。患者能够在栓塞后4周恢复正常饮食。结论胰十二指肠动脉瘤是一种罕见的内脏动脉瘤,具有多种病因和潜在的致命后果。我们报告了一例与胰腺肿块和十二指肠梗阻相关的胰十二指肠动脉瘤的罕见病例。当免疫缺陷患者出现腹痛和呕吐症状时,这种诊断值得考虑。早期血管内栓塞,结合保守的方法,有效缓解了我们患者的症状。
BACKGROUND When people in their 60s experiences abdominal pain, vomiting, and unexplained weight loss without a history of abdominal surgery, the usual diagnosis is obstruction caused by a neoplastic mass. Nevertheless, in exceptionally rare cases, these symptoms arise from complications linked to a visceral artery aneurysm. CASE REPORT We present a case of a 60-year-old man with immunodeficiency and Sneddon-Wilkinson disease (a rare subcorneal pustular dermatosis), who developed a pancreaticoduodenal aneurysm of uncertain origin, associated with pancreatic mass, retroperitoneal hematoma, and duodenal obstruction. The treatment approach included transcatheter arterial coil embolization with supportive measures such as parenteral nutrition, a nasogastric tube, octreotide administration, and antiemetics. Despite these interventions, persistence gastrointestinal symptoms prompted an endoscopic ultrasound fine-needle aspiration to rule out malignancy. The biopsy confirmed localized fibro-inflammation. Although he was initially considered for a gastro-jejunal bypass, conservative management effectively improved the pancreatic lesion and duodenal obstruction, leading to discontinuation of parenteral nutrition. The patient was able to resume a regular diet 4 weeks after embolization. CONCLUSIONS Pancreaticoduodenal artery aneurysm is a rare visceral aneurysm with multiple etiologies and potentially fatal consequences. We report an unusual case of a pancreaticoduodenal artery aneurysm associated with pancreatic mass and duodenal obstruction. This diagnosis warrants consideration when an immunodeficient patient presents symptoms of abdominal pain and vomiting. Early endovascular embolization, combined with conservative approaches, effectively alleviated the symptoms in our patient.