{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:00:27Z","timestamp":1790694027398,"version":"4.1.0"},"reference-count":15,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,9,15]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2026-275687","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:32:50Z","timestamp":1790692370000},"page":"e275687","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Duodenal perforation and retroperitoneal abscess after coil embolisation of an inferior pancreaticoduodenal artery pseudoaneurysm in a patient previously treated with bevacizumab"],"prefix":"10.1136","volume":"19","author":[{"given":"Haruka","family":"Nakashima","sequence":"first","affiliation":[{"name":"Kawasaki Medical School, Kurashiki, Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Okawaki","sequence":"additional","affiliation":[{"name":"Advanced Oncology, Kawasaki Medical School, Kurashiki, Okayama, Japan"},{"name":"Clinical Oncology, Kawasaki Medical School Hospital, Kurashiki, Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Adachi","sequence":"additional","affiliation":[{"name":"Kawasaki Medical School, Kurashiki, Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4236-350X","authenticated-orcid":false,"given":"Takeshi","family":"Nagasaka","sequence":"additional","affiliation":[{"name":"Advanced Oncology, Kawasaki Medical School, Kurashiki, Okayama, Japan"},{"name":"Clinical Oncology, Kawasaki Medical School Hospital, Kurashiki, Okayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"2026092907202694000_19.9.e275687.1","doi-asserted-by":"crossref","first-page":"351","DOI":"10.3348\/kjr.2016.17.3.351","article-title":"Interventional Radiology in the Management of Visceral Artery Pseudoaneurysms: A Review of Techniques and Embolic Materials","volume":"17","author":"Madhusudhan","year":"2016","journal-title":"Korean J Radiol"},{"key":"2026092907202694000_19.9.e275687.2","doi-asserted-by":"crossref","DOI":"10.3390\/jcm10112520","article-title":"Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives","volume":"10","author":"Venturini","year":"2021","journal-title":"J Clin Med"},{"key":"2026092907202694000_19.9.e275687.3","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1055\/s-0043-1761292","article-title":"Clinical Profile, Management, and Outcome of Visceral Artery Pseudoaneurysms: 5-Year Experience in a Tertiary Care Hospital","volume":"32","author":"Shera","year":"2023","journal-title":"Int J Angiol"},{"key":"2026092907202694000_19.9.e275687.4","doi-asserted-by":"publisher","DOI":"10.1148\/radiographics.22.4.g02jl13881"},{"key":"2026092907202694000_19.9.e275687.5","doi-asserted-by":"crossref","first-page":"330","DOI":"10.3400\/avd.cr.20-00011","article-title":"Understanding Vascular Anatomy is Key to Successful Endovascular Treatment of Pancreaticoduodenal Artery Aneurysms","volume":"13","author":"Hirano","year":"2020","journal-title":"Ann Vasc Dis"},{"key":"2026092907202694000_19.9.e275687.6","doi-asserted-by":"crossref","first-page":"945","DOI":"10.3348\/jksr.2020.81.4.945","article-title":"Embolization of Inferior Pancreaticoduodenal Artery Aneurysm with Celiac Stenosis or Occlusion: A Report of Three Cases and a Review of Literature","volume":"81","author":"Kwag","year":"2020","journal-title":"J Korean Soc Radiol"},{"key":"2026092907202694000_19.9.e275687.7","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1007\/s00270-003-0032-y","article-title":"Transcatheter arterial embolization for large pancreaticoduodenal artery aneurysm with mechanically detachable coils","volume":"27","author":"Shibata","year":"2004","journal-title":"Cardiovasc Intervent Radiol"},{"key":"2026092907202694000_19.9.e275687.8","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjc.6603813"},{"key":"2026092907202694000_19.9.e275687.9","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(09)70112-3"},{"key":"2026092907202694000_19.9.e275687.10","unstructured":"Genentech, Inc . 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