Pancreaticoduodenal Artery Aneurysm in a Patient with Celiac Artery Atresia

Visceral artery aneurysms have an array of presentations and management strategies. Pancreaticoduodenal artery aneurysms (PDAAs) are rare, potentially lethal, and necessitate treatment. We present the case of a PDAA in a patient with a congenitally hypoplastic celiac artery treated by open surgical reconstruction.

A 60-year-old female presented with an incidental 2-cm proximal inferior PDAA. Significantly, her celiac trunk was hypoplastic and all flow to the hepatic, gastric, and splenic arteries stemmed from a dilated superior mesenteric artery. The PDAA was located 1 cm from the origin of the pancreaticoduodenal artery at the superior mesenteric artery and was adhered to the fourth portion of the duodenum. Considering her anatomy, open repair with reconstruction of the pancreaticoduodenal artery was pursued via a midline laparotomy, resection of the PDAA, and primary end-to-side pancreaticoduodenal artery to superior mesenteric artery reconstruction. There was an excellent flow into the pancreaticoduodenal artery, gastroduodenal artery, and their emanating branches intraoperatively and on postoperative imaging. The patient progressed well and was discharged home on postoperative day 5. Liver function tests were serially checked and were within normal limits upon discharge.

We demonstrate a safe and successful surgical option for patients with PDAA who required preserved gastroduodenal aneurysm flow.