Abstract
We herein report the case of a ruptured pancreaticoduodenal aneurysm that was successfully treated by transcatheter arterial embolization (TAE). The aneurysm had been caused by an increasing blood flow of the pancreaticoduodenal arcade through the superior mesenteric artery due to compression by the median arcuate ligament. The patient was a 70-year-old male who developed sudden abdominal pain and consulted a local doctor. He was thereafter referred to our hospital because his blood pressure at consultation was 80/50 mmHg and an ultrasound examination revealed suspected intraabdominal bleeding. Emergency abdominal computed tomography (CT) showed the presence of a hematoma behind the pancreas head and the neck of the celiac artery was compressed by a median arcuate ligament based on the findings of 3 dimension-CT angiography. Emergency abdominal angiography from the superior mesenteric artery showed an aneurysm of the pancreaticoduodenal artery. We therefore concluded that the pancreatioduodenal aneurysm was due to median arcuate ligament compression syndrome and it had ruptured. TAE using micro-coils was thereafter successfully performed. Our case suggests that the first safest choice for the emergent treatment of a rupture of a pancreaticoduodenal aneurysm is TAE. An indications regarding an operation to cut the median arcuate ligament should be clarified from now on.
