Pancreaticoduodenal artery aneurysm: A case report and review of the literature

Abstract

A case of true pancreaticoduodenal artery (PDA) aneurysm is reported. A calcified lesion was initially detected by plain x-ray films, and an essential diagnosis was made before operation by intravenous digital subtraction angiography (IVDSA). Surgical resection of the aneurysm was performed successfully. Additionally, we reviewed a total of 82 cases with PDA aneurysm out of the 88 cases that had been reported in the English-language literature up to 1993. Fifty-three cases were accompanied by aneurysmal rupture (rupture group), and 29, including our case, were without rupture (nonrupture group). Because of the high mortality rate (49.1%) in the rupture group, a precise diagnosis and adequate treatment of PDA aneurysm before rupture is important. In the nonrupture group, a calcification on radiography appeared in 61.6% of the cases in which aneurysms were not found incidentally; this seems to be a significant indication for angiography. Moreover, intravenous digital subtraction angiography is quite useful for the screening of PDA aneurysm because it is an easy and noninvasive examination.

Spontaneous Rupture of the Pancreaticoduodenal Artery: Three Cases

“…Abdominal pain is the most frequent symptom, but 50% of true PDA aneurysms remain asymptomatic until they rupture [1, 3, 4]. True PDA aneurysms rupture into the retroperitoneum or the peritoneal cavity with equal frequency.…”

“…They rarely bleed into the duodenum or pancreatic duct [5]. Other presentations are related to biliary or portal compression [4, 6]. In their extensive review, Iyomasa et al [4] reported rupture in 53 of 82 cases of PDA aneurysms.…”

“…Other presentations are related to biliary or portal compression [4, 6]. In their extensive review, Iyomasa et al [4] reported rupture in 53 of 82 cases of PDA aneurysms. The majority of the other patients had abdominal pain or jaundice, but in 9 of them the PDA aneurysm was an incidental finding.…”

“…Diagnosis can sometimes be evoked by a calcification rim [4]. Computed tomography is useful and can show pancreatic calcifications and retroperitoneal hematoma or hemoperitoneum [3], but arteriography is essential to obtain the correct diagnosis and evaluation of PDA aneurysms [1, 3, 5].…”

Misdiagnosis of Anterior Superior Pancreaticoduodenal Artery Aneurysm Rupture Likely Due to Segmental Arterial Mediolysis: A Case Report

“…In symptomatic cases, abdominal aneurysm requires prompt diagnosis and treatment [1][2][3] . Segmental arterial mediolysis SAM and median arcuate ligament syndrome MALS were recently demonstrated as specific causes of aneurysm in the pancreaticoduodenal artery arcade [4][5][6][7] .…”