Severe duodenal stenosis due to rupture of PDA aneurysm
A 57‐year‐old man with smoking history and untreated hypertension developed sudden lower abdominal pain. Although abdominal pain disappeared half a day later, abdominal bloating and nausea appeared and got worse gradually.

Physical examination showed epigastric tenderness and a pulsatile, fist‐size mass under the umbilicus. Upper endoscopy showed severe edematous stenosis of the duodenum. Contrast‐enhanced CT revealed severe stenosis at the origin of the celiac artery caused by the midline arcuate ligament, a low‐density retroperitoneal mass lesion, and dilatation of the branches of the pancreaticoduodenal artery.

Accordingly, the diagnosis of duodenal stenosis caused by a retroperitoneal hematoma secondary to rupture of the pancreaticoduodenal artery (PDA) aneurysm was made.

Key Clinical Message
• When a patient complains of nausea, gastrointestinal endoscopy tends to be the first‐choice diagnostic method

• However, physicians must rule out the possibility of
aneurysm rupture by careful physical assessment before performing gastrointestinal endoscopy, which can be extremely dangerous