A case of ruptured pancreaticoduodenal artery pseudoaneurysm following endovascular aneurysm repair in a patient with celiac artery stenosis caused by the median arcuate ligament.

Pancreaticoduodenal artery (PDA) aneurysm is rare. A 79-year-old man with an abdominal aortic aneurysm and celiac artery stenosis caused by median arcuate ligament compression underwent endovascular aneurysm repair. On postoperative day 1, the patient experienced sudden abdominal pain and hypotension. Emergency computed tomography revealed a retroperitoneal hematoma and ruptured pseudoaneurysm at the pancreatic head. Angiography confirmed the rupture of PDA pseudoaneurysm that was treated successfully with coil embolization. Celiac artery stenosis and coverage of inferior mesenteric artery by endovascular aneurysm repair increased dependence on superior mesenteric artery-PDA arcade, resulting in a flow surge that may have precipitated rupture of pseudoaneurysm.