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Pancreaticoduodenal artery aneurysm secondary to MALS is extremely rare, but potentially life-threatening.
1--common hepatic artery, 2--proper hepatic artery, 3--gastroduodenal artery, 4--left hepatic artery, 5--right hepatic artery, 6--accessory left hepatic artery, 7--right gastroepiploic artery, 8--superior posterior pancreaticoduodenal artery, 9--superior duodenal artery, 10--right gastric artery, 11--the branch of the superior anterior pancreaticoduodenal artery, 12--portal vein, 13--liver, 14--common bile duct, 15--gall bladder, 16--duodenum, 17--pancreas, 18--intermediate hepatic artery.
In addition, the feeding artery from the superior pancreaticoduodenal artery could not be seen from celiac catheterization.
Gundersen III, "Ruptured pancreaticoduodenal artery aneurysms and pheochromocytoma in a pregnant patient with neurofibromatosis," Surgery, vol.
ABBREVIATIONS: RHA--right hepatic artery, LHA--left hepatic artery, HAP--hepatic artery proper, GDA--gastroduodenal artery, SPA--superior pancreaticoduodenal artery, ARHA--accessory right hepatic artery, CHD--common hepatic duct, BD--bile duct, CT--celiac trunk, SMA--superior mesenteric artery, CA--cystic artery, ReHA--replacing hepatic artery
According to Vimalaraj et al.[8], in a case series of 31 HP patients, they had identified the bleeding source arising from the splenic artery (n = 17), gastroduodenal artery (n = 5), superior pancreaticoduodenal artery (n = 1), inferior pancreaticoduodenal artery (n = 2) and from the superior mesenteric artery (n = 1).
Management of pancreaticoduodenal artery aneurysms presenting as catastrophic intraabdominal bleeding.
Celiac trunk stenosis with contrast extravasation of contrast material from the ruptured aneurysm arising in the anterior inferior pancreaticoduodenal artery was found.
Pancreaticoduodenal artery (PDA) aneurysms constitute around 2% of all splanchnic aneurysms [1].
Right hind approach PD was also performed in emergency in two cases of pancreatic head bleeding pseudoaneurysm, with early ligation of the pseudoaneurysm feeding artery, originating from the inferior pancreaticoduodenal artery. Seven patients with borderline resectable ductal adenocarcinoma involving the portomesenteric confluence required en bloc resection, mobilization of the right colon, and mesentery root followed by mesentericoportal venovenous suture.

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