Abstract
We report a complicated case of the pancreaticoduodenal aneurysm with celiac axis stenosis due to compression of the median arcuate ligament. A 63-year-old woman consulted a local doctor with a chief complaint of acute epigastralgia. The patient was referred to our hospital because of mild anemia and hypotension. On admission her vital signs were relatively stable. Abdominal CT scan showed the dilated pancreaticoduodenal arcade with surrounding hematoma, the pancreaticoduodenal aneurysm (PDAA), celiac axis stenosis and poststenotic dilatation of the celiac artery. Therefore, we concluded that the PDAA was due to celiac axis compression syndrome (CACS) and rupture of the dilated pancreaticoduodenal arcade occurred. Transarterial embolization of the dilated pancreaticoduodenal arcade using a micro-coil was performed to prevent rerupture. We considered it is hard to dilate the celiac axis using a stent. We performed release of the median arcuate ligament under laparotomy in order to prevent the recurrence of the PDAA. We thought that an intraoperative ultrasonic flow measurement of the hepatic artery was very useful to check the release of stenosis. One month after the surgical procedure, coil embolization of the PDAA was performed because the PDAA showed no sign of shrinkage. One year after the hybrid therapy, CT showed no evidence of new development of the PDAA. In tandem with the technological advance and device improvement, total transarterial embolization and simultaneous stenting of the stenotic celiac trunk using self-expandable stents is likely to become less invasive and more suitable procedure for PDAA complicated with CACS.
