Hybrid Approach with Superior Mesenteric Artery Balloon Occlusion during Pancreaticoduodenectomy for Pancreatitis-Related Pseudoaneurysm

Visceral pseudoaneurysms are rare, life-threatening complications of pancreatitis. Although endovascular embolization is the first-line treatment, surgery may be required when embolization fails. We report a successful hybrid endovascular-surgical approach in a 66-year-old man with chronic alcohol use and recurrent pancreatitis who presented with acute abdominal pain. Computed tomography revealed a 3-cm pseudoaneurysm arising from the proximal superior mesenteric artery (SMA). Embolization was unsuccessful because the feeding branch could not be identified and severe vascular tortuosity prevented stable superselective catheterization. Urgent pylorus-preserving pancreaticoduodenectomy was performed with temporary SMA occlusion using a balloon catheter inserted via the right femoral artery. Balloon inflation controlled intraoperative bleeding, improved visualization, and facilitated safe dissection in severely inflamed tissue. Hemorrhage was successfully controlled without ischemic or major postoperative complications, and the patient recovered uneventfully. Hybrid endovascular-surgical management with selective SMA balloon occlusion may provide effective bleeding control for pancreatitis-associated pseudoaneurysms unsuitable for embolization.