• Yeongtae Park, Yook Kim, Jisun Lee, Bum S Cho, and Jin Y Lee.
• Department of Radiology, Chungbuk National University Hospital.
• Medicine (Baltimore). 2020 Oct 2; 99 (40): e22531.

RationaleAlthough surgery has been the standard treatment for pancreaticoduodenal trauma because of the complex anatomical relation of the affect organs, transcatheter arterial embolization (TAE) has recently been introduced as a safe and effective treatment. However, TAE for pancreaticoduodenal arterial hemorrhage (PDAH) can be challenging because it is difficult to localize the involved artery and to embolize the bleeding completely due to the abundant collateral channels of the pancreaticoduodenal artery (PDA).Patient ConcernsHerein, we report 2 cases of PDAH that occurred after falling down in case 1 and a pedestrian traffic accident in case 2.DiagnosesMultidetector computed tomography scan revealed massive retroperitoneal hematoma with active extravasation of contrast media from the PDA without any duodenal perforation or advanced pancreatic injury in both patients.InterventionsAll patients were successfully treated using only TAE with a combination of microcoils and n-butyl cyanoacrylate (NBCA) in case 1, and only NBCA in case 2.OutcomesThere was no complication such as duodenal ischemia or pancreatitis. Laparotomy was not needed after TAE.LessonsIn selective PDAH cases, TAE may be a reasonable alternative to emergency laparotomy. It is expected that a careful and repetitive approach, based on complete angiography and embolization with a permanent liquid embolic agent such as NBCA could increase the success rate of TAE.

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