We report a case of 48 year-old man with an infrarenal aortic tumor, presented with a contained rupture and osteolytic lesion of the third lumbar vertebra. The aortic tumor was resected en-bloc with graft interposition. Histological exam revealed poorly differentiated mesenchymal cells extending widely into the intima and also invading vigorously through the media destroying the wall structure. In spite of adjuvant chemo-radiotherapy, multiple lung metastasis appeared 1-year after the operation and the patient died due to rupture of the anastomotic pseudoaneurysm 35 months after operation. We report its clinical-course with the diagnostic imaging, applied therapy, and pathological findings of the resected specimen and autopsy.
A contrast abdominal computed tomography (CT) scan indicated the rupture of a pancreaticoduodenal arterial aneurysm into the duodenum with celiac artery stenosis in a 56-year-old woman with acute abdomen and vomiting of fresh blood. Catheter embolization was performed for the aneurysm, but was unsuccessful. Therefore, ligation of the inflow vessels and resection of the median arcuate ligament were performed after laparotomy. After surgery, contrast abdominal CT confirmed a decrease in the size of the aneurysm and improvement in the celiac artery stenosis. The patient did not develop any postoperative complications and was discharged on day 22 of hospitalization. Several studies have reported a pancreaticoduodenal arterial aneurysm complicated with celiac artery stenosis; however, rupture of a pancreaticoduodenal arterial aneurysm into the duodenum complicated with celiac artery stenosis has seldom been reported.