Inferior Pancreaticoduodenal Artery Aneurysms: Diagnostic Challenges and Management Outcomes—A Systematic Review of 113 Cases

Background Inferior pancreaticoduodenal artery (IPDA) aneurysms are rare visceral artery aneurysms with high rupture rates and significant mortality. Nonspecific clinical presentation frequently leads to diagnostic delay. We conducted a systematic review to characterize clinical features, diagnostic pitfalls, treatment modalities, and outcomes. Methods A systematic review following PRISMA 2020 guidelines was performed. PubMed, Cochrane Library, and Google Scholar were searched from inception through January 2025. Case reports and series describing adult patients with IPDA aneurysms were included. Fisher exact test was used for categorical comparisons. An illustrative fatal index case is presented. Results 113 patients from 81 publications were analyzed. Mean age was 60.3 ± 12.0 years with male predominance (62.3%). Rupture occurred in 70.2% of cases. Overall mortality was 9.6% (10/104). Abdominal pain was the most common presentation (71.7%). Diagnostic pitfall was documented in 47.4% of cases. Celiac axis stenosis was identified in 71.7% of patients. Endovascular treatment was associated with numerically lower mortality than open surgery (3.5% vs 14.3%; OR 0.22; 95% CI: 0.04-1.28; P = 0.08; non-significant). Retroperitoneal hemorrhage predominated among ruptured cases (58.9%). Conclusions Inferior pancreaticoduodenal artery aneurysms present significant diagnostic challenges due to nonspecific symptoms. High clinical suspicion is warranted in patients with unexplained abdominal pain, particularly those with celiac axis stenosis. A stepwise approach—stabilization, endovascular therapy first, and surgical backup—is endorsed by current guidelines. Multidisciplinary team involvement is essential. Mortality is driven primarily by the systemic consequences of hemorrhagic shock rather than by procedural failure; whether earlier recognition reduces mortality cannot be determined from this data set and warrants prospective study.