Pseudoaneurysm of the gastroduodenal artery with arterio-duodenal fistulization secondary to acute pancreatitis: an unusual endoscopic diagnosis
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Keywords:
Gastroduodenal artery
Pseudoaneurysm
Duodenal Diseases
Visceral artery pseudoaneurysm as a cause of upper gastrointestinal bleeding is a rare occurrence. These pseudoaneurysms occur most commonly in the splenic artery but have been reported in the gastroduodenal artery as well, albeit with a high mortality rate in cases of rupture. We present a case of a gastroduodenal pseudoaneurysm presenting with upper gastrointestinal bleeding and causing a mass effect on the pancreatic duct as well.
Pseudoaneurysm
Gastroduodenal artery
Upper Gastrointestinal Bleeding
Gastrointestinal bleeding
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INTRODUCTION: Peripancreatic arterial pseudoaneurysm is a rare but potentially lethal complication of severe acute pancreatitis because it can massively bleed into the gastrointestinal tract. Since surgical treatment of such cases has a high mortality, percutaneous angiographic embolization of bleeding artery has recently been advocated as an alternative therapy. We report a case of acute pancreatitis complicated by gastrointestinal hemorrhage due to a ruptured gastroduodenal artery pseudoaneurysm, in which hemostasis was achieved by transcatheter arterial embolization. CLINICAL CASE: A 65-year-old woman was transferred from another hospital with a diagnosis of severe acute biliary pancreatitis, and having had hematemesis. Upper GI endoscopy detected bleeding from the papilla of Voter, and CT showed hemorrhage in a pseudocyst at the pancreatic head. Angiography revealed active bleeding from an arterial pseudoaneurysm of the gastroduodenal artery: hematemesis was considered to result from rupture of the pseudoaneurysm (hemosuccus). Transcatheter arterial embolization was performed by a 2-step procedure, both through the celiac trunk, that was stenotic, and through the superior mesenteric artery, and hemostasis was achieved. CONCLUSIONS: We conclude that transcatheter arterial embolization is a minimally invasive and highly effective treatment for acute bleeding from a ruptured pseudoaneurysm secondary to acute pancreatitis.
Pseudoaneurysm
Gastroduodenal artery
Arterial Embolization
Bleed
Gastrointestinal bleeding
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Pancreatic pseudoaneurysm is a rare vascular complication of pancreatitis, resulting from erosion of the pancreatic or peripancreatic artery into a pseudocyst. However, it may happen after pancreatic or gastric bypass surgery or trauma. It may lead to fatal complications if left untreated. Herein, we report a unique case of pseudoaneurysm from a gastroduodenal artery in a patient with recurrent episodes of acute pancreatitis, which was managed successfully with coil embolization.
Pseudoaneurysm
Gastroduodenal artery
Pancreatic pseudocyst
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Pseudoaneurysm
Gastroduodenal artery
Etiology
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Pseudoaneurysm
Gastroduodenal artery
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Hemosuccus pancreaticus is a rare form of upper gastrointestinal bleeding that accounts for roughly 1 in 1500 cases. It is characterized by hemorrhage from the ampulla of Vater secondary to rupture of a peripancreatic pseudoaneurysm or visceral artery pseudoaneurysm. Among the visceral artery pseudoaneurysms, gastroduodenal artery pseudoaneurysms are among the rarest. In this case report, we describe a successful coil embolization of a large ruptured gastroduodenal pseudoaneurysm in a patient with massive gastrointestinal bleeding.
Gastroduodenal artery
Pseudoaneurysm
Ampulla of Vater
Gastrointestinal bleeding
Upper Gastrointestinal Bleeding
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Post operative pseudoaneurysm of the gastroduodenal artery is a very rare entity. Rupture of the pseudoaneurysm can be treated by embolism of the artery. A 71 years old male with a perforated pyloric ulcer was treated with controlled external duodenal fistula. Due to postoperative bleeding a subtotal gastrectomy was performed. A second episode of bleeding occurred and rupture of a pseudoaneurysm of the gastroduodenal artery was diagnosed by computed angiography and treated by embolism of the artery. Three days later the duodenal stump was ruptured and a new controlled external duodenal fistula was surgically created. The patient died 6 weeks later due to multiple organ failure. Pseudoaneurysm is the result of self-contained ruptures of one or more layers of the vascular wall. Computed angiography is the golden standard to identify pseudoaneurysms (100% sensitivity). Early suspicion for the presence of a pseudoaneurysm is crucial, as when the rupture actually occurs, the mortality rate is remarkably high. Endovascular approach is a minimally invasive procedure with high success rates (70–100%) and significantly lower morbidity and mortality rates. Surgical is reserved in case of bleeding recurrence. The fact that is particularly interesting in this patient is the timing of the formation of the pseudoaneurysm, considering the fact that 48 h earlier the gastroduodenal artery appeared normal. There are no guidelines regarding the treatment of the pseudoaneurysm of the gastroduodenal artery. It seems reasonable to treat them immediately after diagnosis because a possible rupture of the aneurysm has an extremely high mortality.
Pseudoaneurysm
Gastroduodenal artery
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A bleeding pseudoaneurysm of the peripancreatic artery can present with massive upper gastrointestinal hemorrhage. History of pancreatitis and urgent imaging are crucial in the making of the diagnosis. Here, we report a patient with alcoholic chronic pancreatitis presented with ruptured pseudoaneurysm of gastroduodenal artery (GDA). He was treated with percutaneous angiographic embolisation.
Pseudoaneurysm
Gastroduodenal artery
Gastrointestinal bleeding
Upper Gastrointestinal Bleeding
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We describe the successful n-butyl cyanoacrylate (NBCA) packing of a large gastroduodenal artery pseudoaneurysm after distal pancreatectomy in a patient with a history of subtotal esophagectomy and gastric tube reconstruction. The pseudoaneurysm was considered to be caused by direct injury to the gastroduodenal artery (GDA). However, embolization of the GDA was not possible in this case because due to prior esophageal surgery, the main blood vessel supplying the gastric tube was the right epigastric artery from the GDA. Packing a pseudoaneurysm with NBCA is a treatment option when preservation of the parent artery is required.
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Gastroduodenal artery
Esophagectomy
Distal pancreatectomy
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