Pancreaticoduodenal artery (PDA) aneurysms are rare and often found in association with lesions of the celiac axis. We report the case of a 72-year-old morbidly obese male who presented with chronic abdominal pain and a 4.5 cm inferior PDA aneurysm with associated occlusion of the celiac axis. The patient was treated successfully with right renal to common hepatic artery bypass followed by aneurysm ligation and excision. When encountered, PDA aneurysms require expeditious treatment. Precise definition of vascular anatomy and collateral flow is mandatory. While endovascular techniques may aid in management, surgery remains the most effective treatment for complex aneurysms of the pancreaticoduodenal arteries.
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