Emergency pancreaticoduodenectomy for bleeding pancreatic pseudoaneurysm in patient with common mesentery and replaced right hepatic artery.

Pancreaticoduodenectomy is infrequently performed in emergency, so much the less in lack of traumatic evidence.A rare vascular complication of the pancreatic pseudocyst,the pseudoaneurysm, presents as a pulsating malformation which may lead to life-threatening bleeding if left untreated.Its optimal treatment remains controversial. Most authors agree that angioembolization is the first step to stabilize the patient's condition, with further surgery if such be the case.We herein report an unusual case of pancreatic head pseudocyst complicated with a bleeding pseudoaneurysm arising from the inferior pancreaticoduodenal artery, in a patient with multiple comorbid conditions, common mesentery,hepatic artery variant and hemodynamic instability. An emergency early retropancreatic approach pancreaticoduodenectomy was performed with uneventful immediate and long-term outcome. We highlight that emergency surgery allowed both rapid control over the bleeding with hemostasis and removal of the pseudocyst. This is particularly relevant in high-risk patients in whom selective angioembolization is no more of choice. Celsius.