A Case of the Anterior Superior Pancreaticoduodenal Artery Aneurysm with Complete Occlusion of the Superior Mesenteric Artery

Masaomi Ichinokawa¹⁾²⁾, Kazuhiro Iwai¹⁾, Yoshiyuki Matsumura¹⁾²⁾, Seiji Mega¹⁾, Ryousuke Kawasaki¹⁾, Toru Takahashi¹⁾ and Satoshi Kondo²⁾

Department of Surgery, Oji General Hospital¹⁾
Department of Surgical Oncology, Hokkaido University Graduate School of Medicine²⁾

Aneurysms of the pancreaticoduodenal arteries are rare and account for only 2% of aneurysms in the splanchnic circulation. We report a case of anterior superior pancreaticoduodenal artery aneurysm with complete occlusion of the superior mesenteric artery at its origin. A 76-year-old woman was admitted to our hospital, because an asymptomatic splanchnic aneurysm had been detected by abdominal ultrasonography during a screening examination. Selective angiography showed that the aneurysm was 30 mm in diameter and located in the anterior superior pancreaticoduodenal artery, and an aortogram showed complete occlusion of the superior mesenteric artery at its origin. Since it seemed very difficult to perform the complete coil embolization of the aneurysm and we were concerned about ischemia of the superior mesenteric artery, we performed aneurysectomy by open surgery. Pathological examination showed degeneration of the smooth muscle tissue in tunica media. The aneurysm was probably caused by hemodynamic stress produced by the increased flow in compensation for the complete occlusion of the superior mesenteric artery at its origin. The patient is doing well as of 5 months postoperatively.

Key words
pancreaticoduodenal artery, aneurysm, occlusion of the superior mesenteric artery

Reprint requests
Masaomi Ichinokawa Department of Surgical Oncology, Hokkaido University Graduate School of Medicine
N15W7 Kita-ku, Sapporo, 060-8638 JAPAN

Accepted
March 22, 2006

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