Two patients with ruptured posterior inferior pancreaticoduodenal artery aneurysms associated with compression of the celiac axis by the median arcuate ligament.

Patients with compression of the celiac axis by the median arcuate ligament may develop aneurysms in the pancreaticoduodenal arcades. We experienced two cases of ruptured pancreaticoduodenal artery aneurysm associated with this condition. Both patients presented with abdominal pain and shock, and abdominal contrast-enhanced computed tomography showed retroperitoneal hematoma and compression of the celiac axis by the median arcuate ligament. Both patients were successfully treated by coil embolization. Patients with celiac axis compression or stenosis may develop recurrent aneurysms unless revascularization of the celiac axis is performed. Long-term follow-up is required because aneurysms may develop after 10 years or longer.