A 59-year-old man was admitted with sudden onset of back pain and abdominal discomfort. There was no history of pancreatitis, abdominal injury, or abdominal surgery. Enhanced abdominal computed tomography (CT) showed retroperitoneal hematoma behind the head of the pancreas, and emergency angiography demonstrated retroperitoneal bleeding due to rupture of a superior pancreaticoduodenal artery aneurysm. Embolization was tried unsuccessfully, because of difficulty in selective cannulation of the vessel feeding the aneurysm. Emergency laparotomy was performed. We inserted a finger behind the pancreas via the lateral side of the duodenum by Kocher's maneuver, then ligated the ruptured portion of the superior pancreaticoduodenal artery. We did not reconstruct the artery because blood supply to the peripheral tissue was good. The patient's postoperative course was uneventful, and he was discharged from the hospital in good condition 1 month after surgery. CT proved to be useful in revealing the voluminous retroperitoneal hematoma, and angiography proved to be necessary for the definitive diagnosis of pancreaticoduodenal artery aneurysm.

Many medical schools have recently introduced clinical exposure in the early years of training. During this period of early clinical exposure, medical students observe many aspects of a hospital and its staff. Because they do not yet have any special knowledge of medicine, medical students are able to understand problems in medicine from a patient's point of view. We sent questionnaires to students of several medical schools and investigated what students learned, especially about communication. We reported on voluntary research by some medical students at Osaka University. We believe that early clinical exposure gives medical students a chance to recognize and consider many aspects of medicine.