Surgical resection is the only curative treatment for perihilar cholangiocarcinoma (pCCA); however, the majority of patients experience postoperative recur

Pancreatic arcade aneurysms are uncommon vascular lesions but may be fatal when rupture occurs. We describe the case of a 68-year-old woman who presented with hematemesis and profound anemia and was diagnosed with multiple pancreaticoduodenal artery aneurysms associated with median arcuate ligament syndrome (MALS). Contrast-enhanced computed tomography (CT) revealed a severe stenosis of the celiac artery origin with post-stenotic dilatation and aneurysmal changes within the pancreatic arterial arcade. Active bleeding from a ruptured posterior superior pancreaticoduodenal artery (PSPDA) aneurysm was successfully controlled by emergency coil embolization. To address the underlying hemodynamic abnormality and reduce the risk of further aneurysm formation or rupture, elective laparoscopic median arcuate ligament release was subsequently performed. Intraoperative Doppler ultrasonography demonstrated the restoration of antegrade hepatic arterial flow following decompression. This case highlights the importance of combining endovascular and surgical approaches in the management of pancreatic arcade aneurysms associated with MALS, with careful long-term follow-up.