title: Ruptured Pancreaticoduodenal Artery Aneurysms Associated with Celiac Stenosis Caused by the Median Arcuate Ligament: A Poorly Known Etiology of Acute Abdominal Pain.
abstract: OBJECTIVE
  Pancreaticoduodenal artery (PDA) aneurysm is a rare but clinically important form of vascular disease. A small proportion of these aneurysms are caused by compression of the artery by the median arcuate ligament (MAL). The objective of the study was to establish whether it is feasible and effective to treat ruptured PDA aneurysms without treating the celiac stenosis caused by the MAL.
  
  
  METHODS
  From January 2007 to November 2014, 10 patients were included. Standard embolization or surgical procedures were used to treat the ruptured aneurysms, but the celiac stenosis itself was not treated. The primary end point was the feasibility and efficacy of embolization for the treatment of ruptured PDA aneurysms. The secondary end points included clinical data, imaging findings, the success rate of embolization and the outcome during follow up.
  
  
  RESULTS
  All patients presented with acute, non-specific epigastric pain with nausea. An abdominal computed tomography scan revealed peri-pancreatic hematoma in all cases, and PDA aneurysms were visible in six patients. The aneurysms ranged from 2 mm to 10 mm in diameter and were variously located on the anterior PDA (n = 1), the posterior PDA (n = 3), and the branch of the dorsal pancreatic artery (n = 6). Surgery was performed in two cases (with one death). Embolization was successful in the other eight cases. The median length of hospital stay was 10 days (range 8-25 days). Over a median follow up period of 11 months (range 5-48 months), none of the PDA aneurysms recurred.
  
  
  CONCLUSIONS
  Rupture of a PDA aneurysm caused by the MAL should always be considered in the differential diagnosis of acute abdominal pain, because the condition requires specific management. Embolization is safe and has a high success rate. Surgery should only be performed when embolization fails.
authors.affiliation: Department of Radiology, Amiens University Medical Center, Avenue René Laennec, F-80054 Amiens cedex 01, France.
authors.forename: C
authors.initials: C
authors.lastname: Chivot
authors.affiliation: Department of Digestive Surgery, Amiens University Medical Center, Avenue René Laennec, F-80054 Amiens cedex 01, France.
authors.forename: L
authors.initials: L
authors.lastname: Rebibo
authors.affiliation: Department of Radiology, Amiens University Medical Center, Avenue René Laennec, F-80054 Amiens cedex 01, France.
authors.forename: B
authors.initials: B
authors.lastname: Robert
authors.affiliation: Department of Digestive Surgery, Amiens University Medical Center, Avenue René Laennec, F-80054 Amiens cedex 01, France; EA4294, Jules Verne University of Picardie, F-80054 Amiens cedex 01, France; Clinical Research Center, Amiens University Medical Center, Avenue René Laennec, F-80054 Amiens cedex 01, France. Electronic address: regimbeau.jean-marc@chu-amiens.fr.
authors.forename: J-M
authors.initials: JM
authors.lastname: Regimbeau
authors.affiliation: Department of Radiology, Amiens University Medical Center, Avenue René Laennec, F-80054 Amiens cedex 01, France.
authors.forename: T
authors.initials: T
authors.lastname: Yzet
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology*; D059787:Acute Pain / Q000175:diagnosis / Q000209:etiology*; D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D002445:Celiac Artery / Q000002:abnormalities*; D003251:Constriction, Pathologic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D003937:Diagnosis, Differential; D004386:Duodenum / Q000098:blood supply*; D004621:Embolization, Therapeutic; D005240:Feasibility Studies; D005260:Female; D005602:France; D006801:Humans; D007902:Length of Stay; D008297:Male; D000074742:Median Arcuate Ligament Syndrome; D008875:Middle Aged; D010179:Pancreas / Q000098:blood supply*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
keywords: Celiac stenosis; Embolization; Median arcuate ligament; Pancreaticoduodenal artery aneurysm; Peri-pancreatic hematoma