Visceral artery aneurysms are located only 1.3-2% in pancreaticoduodenal artery. Rupture risk is 15-22% and they are related to about 40% death if rupture occurs, rupture risk is not related to the aneurysm size. Pancreaticoduodenal artery aneurysm secondary median arcuate ligament syndrome was diagnosed in 45-years old female. Because of the big size of aneurysm which was 3.5 centimetres in diameter, instead of embolization the aneurysm was treated by open surgical approach with resection of the aneurysm with preventing head of pancreas and re-implantation of celiac trunk to the abdominal aorta. Regardless of their size, pancreaticoduodenal artery aneurysms must be treated. The issue of treatment options of pancreaticoduodenal artery aneurysm is still controversial, recently endovascular treatment has become popular but open surgical repair is rational option for young patients with no malignancy, for whom long term survival is expected.
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