Duodenal perforation and retroperitoneal abscess after coil embolisation of an inferior pancreaticoduodenal artery pseudoaneurysm in a patient previously treated with bevacizumab.
TL;DR
A man in his 70s with metastatic rectal cancer previously treated with bevacizumab who developed duodenal perforation and retroperitoneal abscess 15 days after embolisation of an inferior pancreaticoduodenal artery pseudoaneurysm using coils and adjunctive N-butyl cyanoacrylate-Lipiodol is reported.
Abstract
Transcatheter arterial embolisation is an established treatment for visceral pseudoaneurysms and pancreaticoduodenal arcade embolisation is generally well tolerated because of rich collateral flow. We report a man in his 70s with metastatic rectal cancer previously treated with bevacizumab who developed duodenal perforation and retroperitoneal abscess 15 days after embolisation of an inferior pancreaticoduodenal artery pseudoaneurysm using coils and adjunctive N-butyl cyanoacrylate-Lipiodol. He improved with broad-spectrum antibiotics, CT-guided drainage and conservative management, avoiding emergency surgery. The course is compatible with a multifactorial process in which procedure-related local ischaemic stress, altered collateral reserve, prior surgical alteration of regional vessels and impaired tissue repair after prior bevacizumab and recent fruquintinib exposure may have contributed. Pancreatic inflammation or leakage was not confirmed but remains a possible alternative or interacting mechanism. Causality cannot be established from a single case.