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A 64-year-old man presented with epigastric pain and underwent contrast-enhanced computed tomography. Ruptured aneurysm of the inferior pancreaticoduodenal artery was diagnosed. TAE was successfully accomplished using coils, but vomiting appeared 9 days later. Duodenal stenosis was diagnosed from contrast-enhanced computed tomography and upper gastrointestinal endoscopy and was attributed to edematous changes in the duodenum. Conservative management led to successful recovery and discharge.

Visceral aneurysms of the pancreaticoduodenal arcades are rare. Although these aneurysms are often asymptomatic and identified incidentally on cross-sectional imaging, aneurysm rupture presents significant morbidity. Ruptured pancreaticoduodenal arcade aneurysms typically present with abdominal pain, hemorrhagic shock, or gastrointestinal bleeding. A 72-year-old male presented with nausea and vomiting and was found to have imaging evidence of duodenal obstruction. This was due to a duodenal intramural hematoma caused by a ruptured submucosal aneurysm supplied by a branch of the inferior pancreaticoduodenal artery in the presence of median arcuate ligament compression of the celiac artery. This was subsequently treated with endovascular embolization with clinical improvement in duodenal obstruction. This case illustrates an unusual presentation of a ruptured pancreaticoduodenal arcade aneurysm. Keywords: Pancreaticoduodenal artery aneurysm, Duodenal stenosis, Duodenal obstruction