Silent Threat in the Abdomen: A Pancreaticoduodenal Artery Aneurysm Unmasked by Recurrent Epigastric Pain
Abstract
Pancreaticoduodenal artery aneurysms are rare visceral arterial aneurysms with a high risk of rupture, which is
not necessarily related to aneurysm size. We report a 32-year-old woman with recurrent epigastric pain who was
found to have a 20-mm inferior pancreaticoduodenal artery aneurysm associated with significant celiac artery
stenosis and extensive collateral circulation through the pancreaticoduodenal arcade. Because embolization
alone could compromise hepatic perfusion, an aorto-hepatic bypass was performed followed by staged coil
embolization of the aneurysm two weeks later. Complete aneurysm exclusion and graft patency were confirmed
at six-month follow-up, and the patient remained asymptomatic. This case highlights the importance of assessing
celiac artery patency and collateral circulation when managing pancreaticoduodenal artery aneurysms. CTA is
essential for diagnosis and treatment planning, and staged revascularization followed by aneurysm exclusion
may be a safe option in patients with significant celiac artery disease.
2. Ducasse E, Roy F, Chevalier J, Massouille D, Smith M, Speziale F, et al. Aneurysm of the pancreaticoduodenal arteries
with a celiac trunk lesion: current management. J Vasc Surg. 2004;39(4):906-11. https://doi.org/10.1016/j.jvs.2003.09.049
3. Moore E, Matthews MR, Minion DJ, Quick R, Schwarcz TH, Loh FK, et al. Surgical management of peripancreatic arterial aneurysms. J Vasc Surg. 2004;40(2):247-53. https://doi. org/10.1016/j.jvs.2004.03.045
4. Horowitz R, Hoffman S, Argaman M, Dadaev V, Shakkur W, Kanani F. Inferior Pancreaticoduodenal Artery Aneurysms: Diagnostic Challenges and Management Outcomes-A Systematic Review of 113 Cases. Am Surg. 2026;92(6):1123- 35. https://doi.org/10.1177/00031348261457634
5. Tulsyan N, Kashyap VS, Greenberg RK, Sarac TP, Clair DG, Pierce G, et al. The endovascular management of visceral artery aneurysms and pseudoaneurysms. J Vasc Surg.2007;45(2):276-83. https://doi.org/10.1016/j.jvs.2006.10.049
6. Stoecker JB, Eddinger KC, Glaser JD, Wang GJ, Shlansky-Goldberg RD, Fairman RM, et al. A large series of true pancreaticoduodenal artery aneurysms. J Vasc Surg. 2022;75(5):1634-42. https://doi.org/10.1016/j.jvs.2022.01.021
| Files | ||
| Issue | Vol 9 No 1 (2026) | |
| Section | Case Report(s) | |
| Keywords | ||
| Pancreaticoduodenal Artery Aneurysm Celiac Artery Stenosis Abdominal Pain Computed Tomography Angiography Coil Embolization | ||
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