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Pancreatico-Duodenal artery aneurysm a rare cause for chronic


									        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

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.

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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