PMC5664233_01
Contrast-enhanced computed tomography image on admission. A massive hematoma is visible in the small intestine, with mucosal thickening of the duodenal wall, duodenal stenosis at the level of the third and fourth portions of the duodenum, and soft-tissue density (arrow) with fat stranding between the duodenum and aorta.
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Moreover, contrast-enhanced computed tomography (CT) identified no extravasation around the duodenum, but it revealed mucosal thickening of the duodenal wall, duodenal stenosis at the level of the third and fourth portion of the duodenum, and soft-tissue density with fat stranding between the duodenum and the abdominal aorta (Figure 1).
Maximum intensity projection reconstruction of coronal computed tomography angiogram and transverse plane at the level of inguinal region on admission. (a) Diffuse calcification from the abdominal aorta to the left common iliac artery was observed, which was confined to the irradiation field. ((b) and (c)) Irregular stenosis of the abdominal aorta (white arrows) and left femoral artery (arrowhead).
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Contrast CT on admission also revealed the presence of diffuse calcification and stenosis from the left common iliac artery to the abdominal aorta, which was confined to the radiation field (Figure 2).
Perioperative digital subtraction angiograms. Extravasation from the right lateral wall of the abdominal aorta (a) and diffusion of the contrast agent along the duodenum (b) were observed. The celiac, superior mesenteric, and right renal arteries were occluded. A covered stent graft was successfully deployed into the abdominal aorta, and a leak at the end of the graft was treated with balloon angioplasty (c). After placement of the endovascular stent graft, aortography showed no extravasation from the right lateral wall of the abdominal aorta (d).
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Furthermore, extravasation from the right lateral wall of the abdominal aorta and diffusion of the contrast agent along the duodenum were also observed (Figure 3), which suggested that the source of bleeding was a direct communication between the abdominal aorta and the duodenum. The ADF was completely sealed with the covered stent graft (Figure 3(d)).