Tehran University of Medical Sciences (TUMS) Academic Journal of Surgery 2423-3218 9 1 2026 10 25 1 5 Sepideh Aarabi 1 Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran 2 Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran 2026 08 21 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. https://ajs.tums.ac.ir/index.php/ajs/article/view/351