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Pancreatico-Duodenal Artery Aneurysm An Unusual Cause For Chronic Abdominal Pain Navaratne S, Frost R, Ranaboldo C Department of Radiology, Department of Vascular Surgery Salisbury District Hospital Wiltshire Introduction Visceral artery aneurysm is an uncommon clinical problem. Splenic artery aneurysms (SAA) are the most common (60%), followed by hepatic (20%), superior mesenteric (5.9%) and tripod celiac (4%). The first splanchnic artery aneurysm is described in 1745. Case report A 66 Year old lady with no significant past medical history presented to surgical out patient clinic with change in bowel habits and vague intermittent left upper quadrant pain. Her weight and appetite has been steady. Clinical examination was unremarkable. Barium enema study was normal apart from a incidental finding of a calcified ring opacity of 2 cm in diameter at L1 which appears some times to the right some times to the left of the midline in the x rays. Her CT angiogram reviled a 2.5 cm saccular aneurysm of Superior Pancreatico- duodenal artery with a completely occluded Coeliac axis. Patient was fully recovered from the operation after a surgical repair using a vein patch. Follow up duplex showed no further stenosis. Discussion Aneurysms of the Pancreatico-duodenal artery are extremely rare entities. Only about 1–2% of all visceral aneurysms fall in to this category. This may present in the absence of any risk factors. Nearly 30% of these aneurysms evolve as complications of acute or chronic pancreatitis of which 10% occur in patients with chronic pancreatitis. Rupture rate is described as 72% in first decade. Reported mortality rate approaches 40%. In the absence of celiac axis, fore gut of the patient heavily depends on the blood supply from superior pancreatico duodenal artery. Hence early detection and correction is very important in these rare cases.
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