case_images: PMC7748894_01
case_images: Axial CT image showing a large acute retroperitoneal hematoma (asterisk) centered around the paraduodenal region extending anterior to the right anterior pararenal fascia.
case_images: CRIRA2020-8855946.001.jpg
case_images: PMC7748894_01_CRIRA2020-8855946.001.jpg
case_images: fig1
case_images: Sonography revealed free fluid in the right hypochondrium which on CT revealed a large retroperitoneal hematoma, predominant in the paraduodenal region (Figure 1). The initial suspicion was active bleeding arising from the pancreaticoduodenal arteries due to the location of hematoma (Figures 1 and 2), and urgent angiography with the view for embolization was performed.
case_images: Maximum intensity projection (MIP) image showing a focus of active bleeding (arrow) from the vascular arcade running along the mesenteric side of the duodenal c-loop. This was initially thought to represent the pancreaticoduodenal arcade but was found to be an arc of Buhler during angiography. Fusiform dilatation at the site of the active bleeding could be appreciated.
case_images: CRIRA2020-8855946.002.jpg
case_images: PMC7748894_01_CRIRA2020-8855946.002.jpg
case_images: fig2
case_images: The initial suspicion was active bleeding arising from the pancreaticoduodenal arteries due to the location of hematoma (Figures 1 and 2), and urgent angiography with the view for embolization was performed.
case_images: Superior mesenteric arteriography showing the arc of Buhler with a short segment of fusiform dilatation and active extravasation (arrowhead). Hepatofugal flow was seen with brisk opacification of the proper hepatic artery. The cause of which was unknown.
case_images: CRIRA2020-8855946.003.jpg
case_images: PMC7748894_01_CRIRA2020-8855946.003.jpg
case_images: fig3
case_images: In addition to brisk hepatopedal flow, a fusiform aneurysm with a focus of active bleeding was detected (Figure 3).
case_images: Postembolization angiography demonstrating complete stasis and sacrifice of arc of Buhler (zigzag arrow).
case_images: CRIRA2020-8855946.004.jpg
case_images: PMC7748894_01_CRIRA2020-8855946.004.jpg
case_images: fig4
case_images: Completion angiography from both the celiac artery and SMA showed complete stasis of the arc (Figure 4).