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Journal of Gastroenterology

, Volume 33, Issue 3, pp 434–438 | Cite as

Pancreaticoduodenal artery aneurysms associated with celiac axis stenosis due to compression by median arcuate ligament and celiac plexus

  • Kaori Suzuki
  • Hiromasa Kashimura
  • Mikio Sato
  • Mahmudul Hassan
  • Hikaru Yokota
  • Akira Nakahara
  • Hiroshi Muto
  • Kenji Yuzawa
  • Katashi Fukao
  • Naomi Tanaka
Case report

Abstract:

Celiac axis stenosis is frequently associated with pancreaticoduodenal artery aneurysms. Although the cause of stenosis was not clear in most of the reported cases, compression of the median arcuate ligament of the diaphragm was found to be responsible for the stenosis in 7 of 42 reported cases of this type of aneurysm. We report a case of aneurysm caused by compression of the median arcuate ligament of the diaphragm and celiac plexus. An asymptomatic 43-year-old Japanese man was admitted with a low echoic lesion in the uncus of pancreas. Computed tomographic scan and angiogram revealed stenosis of the celiac axis and two aneurysms in the inferior posterior pancreaticoduodenal artery. The celiac plexus and median arcuate ligament were divided surgically and normal flow was reestablished in the celiac axis. One of the aneurysms was resected and the afferent artery of the other aneurysm was ligated. In the setting of pancreaticoduodenal artery aneurysm associated with celiac axis stenosis, management of stenosis should be considered in addition to local treatment of the aneurysm. In this context, division of median arcuate ligament and celiac plexus or aorto-celiac bypass may normalize the flows in the pancreaticoduodenal arcade and could be effective in preventing aneurysm reformation.

Key words: pancreaticoduodenal artery aneurysm celiac axis stenosis median arcuate ligament of diaphragm celiac plexus 

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Copyright information

© Springer-Verlag Tokyo 1998

Authors and Affiliations

  • Kaori Suzuki
    • 1
  • Hiromasa Kashimura
    • 1
  • Mikio Sato
    • 1
  • Mahmudul Hassan
    • 1
  • Hikaru Yokota
    • 3
  • Akira Nakahara
    • 1
  • Hiroshi Muto
    • 1
  • Kenji Yuzawa
    • 2
  • Katashi Fukao
    • 2
  • Naomi Tanaka
    • 1
  1. 1.Departments of Internal Medicine and
  2. 2.Surgery, Division of Gastroenterology, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305, JapanJP
  3. 3.Department of Internal Medicine, Toride Ishikai Hospital, Toride, JapanJP

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