Celiac pseudoaneurysm rupture after ligation in the setting of a pancreatic fistula following penetrating trauma

Trauma to the celiac artery may require ligation as a life-saving maneuver. Our patient sustained a gunshot wound resulting in celiac artery ligation during trauma laparotomy. Abdominal closure occurred the following day with drains placed owing to grade II pancreatic injury. Abdominal drainage was consistent with amylase-rich pancreatic fistula. Serial cross-sectional imaging demonstrated an enlarging celiac artery stump over 2 weeks. On day 15, a ruptured celiac artery pseudoaneurysm was found and treated with embolization and aortic stent graft cuff. This case highlights the importance of aggressive treatment for any enlarging artery in the setting of a pancreatic fistula.