Severe paraduodenal pancreatitis
Chronic abdominal pain and nausea. History of alcohol abuse.
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Extensive inflammatory infiltrate is seen in the pancreatoduodenal region. Duodenum is compressed by multiple cystic structures. Pancreatic and common bile ducts are dilated, there are calcifications in the head of the pancreas. Patient also has celiac artery stenosis due to compression by median arcuate ligament. Blood flow is diverted mainly into gastroduodenal artery, which runs through the center of the infiltrate and has a saccular aneurysm in its distal portion. Sliding hiatus hernia is also noted.
CT findings are consistent with segmental form of paraduodenal pancreatitis. Patient's condition is complicated by presence of median arcuate ligament syndrome and saccular aneurysm of gastroduodenal artery.
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