PMC6171461_01
Pre-operative contrast enhanced CT (A, B) and angiography (C). Jejunal artery aneurysm (asterisk).
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CT revealed the aneurysm in the proximal portion of the first jejunal artery (Fig. 1A, B). Angiography confirmed that endovascular repair was not suitable because the proximal neck of the aneurysm was too short, with the possibility of obstruction of the main trunk of the superior mesenteric artery (SMA) with an endovascular device (Fig. 1C).
Intra-operative findings. (A) Inflow (solid arrow) and outflow (dot arrow) of the aneurysm. (B) Saphenous vein graft interposed.
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The aneurysm was completely exposed by opening the mesojejunum, and mild adhesive inflammatory changes were detected around the aneurysm (Fig. 2A). A saphenous vein graft was interposed with a 7-0 polypropylene suture (Fig. 2B).
Post-operative computed tomographic scan. Patent saphenous vein graft (arrow).
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The patient's post-operative course was uneventful and contrast enhanced CT revealed a patent saphenous vein graft (Fig. 3).
Histopathological examination of the aneurysm suggested heterotopic pancreas. (A) Heterotopic pancreas close to the tunica media (solid arrow). (B) Insulin staining positive islets of Langerhans.
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Histopathological examination showed that there was medial degeneration of the arterial wall with a small nest of digestive glands, suggesting heterotopic pancreas (Fig. 4).