Posterior inferior pancreaticduodenal artery aneurysm rupture due to median arcuate ligament syndrome

      A 73-year-old woman experienced acute abdominal pain, nausea and vomiting during hospitalization for thalamic hemorrhage treatment. An emergent abdominal computed tomography scan revealed bloody ascites and hematoma in the pararenal extraperitoneal space. Vital signs were stable at the moment, however, three days later, the patient presented with hemorrhagic shock. She was transferred to our hospital for further evaluation and treatment. An emergent CT scan showed hematoma in the pararenal extraperitoneal space. A 3D-CT revealed stenosis of the root the celiac artery with a distal dilation (Fig. 1A; surrounded by a circle). Also, a digital subtraction angiography showed a spindle-shaped aneurysm was formed at the posterior inferior pancreatic duodenal artery (PIPDA) (Fig. 1B; Arrowhead). Median arcuate ligament syndrome complicated with PIPDA aneurysm rupture was confirmed in conjunction was diagnosed. The patient subsequently underwent a coil embolization of the aneurysm.
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