Multiple pancreaticoduodenal artery aneurysms with a primary duodenal fistula

摘要

A 48-year-old woman presented with hematemesis and melena. She was a nonsmoker, with a history of hypercholesterolemia. There was no history of alcohol abuse or pancreatitis. She was investigated with a gastroscopy, capsule endoscopy, and push enteroscopy, all of which failed to demonstrate a source of bleeding. She had an episode of syncope associated with a drop in hemoglobin to 47g/L. A computed tomography angiogram demonstrated two saccular aneu-rysms arising from the inferior pancreaticoduodenal artery measuring 2.5 X 1.9 cm and 2.0 X 2.6 cm, with the larger aneurysm closely abutting the third part of the duodenum. A 1.0-cm aneurysm in the distal splenic artery and a 90% celiac trunk stenosis was also identified (A/Cover and B).