Severe paraduodenal pancreatitis

Case contributed by Dr Maxim Stalkov

Presentation

Chronic abdominal pain and nausea. History of alcohol abuse.

Patient Data

Age: 45 years
Gender: Male

Extensive inflammatory infiltrate is seen in the pancreaticoduodenal 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 with characteristic hooked appearance. 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.

Case Discussion

CT findings are consistent with segmental form of paraduodenal pancreatitis. The patient's condition is complicated by the presence of median arcuate ligament syndrome and saccular aneurysm of gastroduodenal artery.

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