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Transarterial embolization for ruptured pancreaticoduodenal artery aneurysm due to segmental arterial mediolysis combined with median arcuate ligament syndrome: a case report

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Abstract

A 75-year-old female with a history of Parkinson’s disease treatment and hypertension presented at the emergency section with sudden onset of right abdominal pain. Contrast-enhanced computed tomography revealed beaded irregular stenosis and dilation of the superior mesenteric artery (SMA) and an aneurysm in the branch of the pancreaticoduodenal artery (PDA) that communicates with the common hepatic artery and SMA. Additionally, a hematoma had formed in the retroperitoneal space, and extravasation of contrast medium from the pancreaticoduodenal artery aneurysm (PDAA) into the hematoma was observed. The celiac artery (CA) was compressed by the median arcuate ligament; stenosis of the CA at its origin and dilation on the distal side were observed. Based on the imaging findings, it was diagnosed that PDAA was ruptured, SMA developed segmental arterial mediolysis (SAM), and CA developed median arcuate ligament syndrome (MALS). The ruptured PDAA was thought to be caused by SAM combined with MALS. Transcatheter arterial embolization (TAE) was performed for the ruptured PDAA. To the best of our knowledge, there have been no reports of TAE for a ruptured PDAA caused by SAM and MALS. After TAE, the PDAA did not re-rupture.

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Acknowledgements

We wish to express our deep appreciation to all the medical staff for their assistance with the procedures.

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Authors and Affiliations

  1. Department of Gastroenterology, Fukushima Rosai Hospital, Iwaki, Fukushima, Japan

    Tatsuro Sugaya, Tomohiro Suzuki, Jun Wada, Hiroshi Shimizu, Daiki Uchihara, Yuko Yokogawa, Osamu Ichii, Mayumi Tai & Yutaka Ejiri

  2. Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan

    Tatsuro Sugaya, Jun Wada, Hiroshi Shimizu & Hiromasa Ohira

Authors
  1. Tatsuro Sugaya
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  2. Tomohiro Suzuki
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  3. Jun Wada
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  4. Hiroshi Shimizu
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  5. Daiki Uchihara
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  6. Yuko Yokogawa
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  7. Osamu Ichii
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  8. Mayumi Tai
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  9. Yutaka Ejiri
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  10. Hiromasa Ohira
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection and analysis were performed by Tatsuro Sugaya, Tomohiro Suzuki. The first draft of the manuscript was written by Tatsuro Sugaya and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Tatsuro Sugaya.

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The authors declare no conflicts of interest for this article.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).

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Informed consent was obtained from all patients to be included in the study.

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Sugaya, T., Suzuki, T., Wada, J. et al. Transarterial embolization for ruptured pancreaticoduodenal artery aneurysm due to segmental arterial mediolysis combined with median arcuate ligament syndrome: a case report. Clin J Gastroenterol 16, 859–863 (2023). https://doi.org/10.1007/s12328-023-01847-1

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  • DOI: https://doi.org/10.1007/s12328-023-01847-1

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