Abstract
We report a rare case of inferior pancreaticoduodenal artery aneurysm with celiac axis occlusion and superior mesenteric artery (SMA) stenosis at its origin. A 42-year-old man with no specific history of disease was referred to our hospital because an asymptomatic visceral artery aneurysm had been found on computed tomography scans during a routine health check. Abdominal aortography revealed celiac trunk occlusion and 90% stenosis of the SMA ostium. In addition, selective SMA angiography scans showed an aneurysm of the inferior pancreaticoduodenal artery 20 mm in diameter and retrograde blood perfusion to the hepatic and splenic artery supplied by the SMA via the pancreaticoduodenal arcade as a collateral pathway. We suspected that the median arcuate ligament caused compression of these arteries. However it was too difficult to detect the ligament because of severe adhesion around the aneurysm and abdominal aorta. Therefore we performed an aneurysectomy and an aorto-splenic bypass with a saphenous vein graft, and the postoperative course was good.
