Bhatti A I, Ahmed R.
Obstructive Jaundice: an unusual presentation of a Superior Mesenteric Artery Aneurysm.
J Pak Med Assoc Jan ;54(3):164-5.

A 47-year-old man was admitted with intermittent episodes of jaundice over a period of two months and pain in the right hypochondrium for the past two weeks. His biochemical assays showed a direct bilirubin of 15.01 mg%, an SGPT of 200 IU/L and alkaline phosphatase to be 758 IU/L. His initial ultrasound showed a possible lesion in the region of the head of pancreas and a diagnosis of carcioma of the head of pancreas was given. An ERCP was performed that showed an abrupt cut-off at the level of the distal common bile duct and a stent was introduced into the CBD bypassing the obstruction. Since the radiographic appearances of the CBD on ERCP were not those commonly seen in association with a carcinoma of the head of pancreas and the gastroenterologist asked for a CT scan to be performed on the patient. The spiral (helical) CT scan showed the presence of a large aneurysm arising from the trunk of the superior mesenteric artery. The aneurysm had a broad neck along the right lateral part of the trunk of the superior mesenteric artery. Its thrombosed portion was extending upto the second part of the duodenum and compressing the distal common bile duct. A digital subtraction angiography was performed on this patient. The celiac arteriogram showed the common hepatic, left hepatic and the left gastric arteries to be normal. The right hepatic artery was not opacified.

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