Gastroduodenal Artery Pseudoaneurysm: A Rare Cause of Upper Gastrointestinal Bleeding and Pancreatic Duct Compression
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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.Keywords:
Pseudoaneurysm
Gastroduodenal artery
Upper Gastrointestinal Bleeding
Gastrointestinal bleeding
A 41-years-old male who presents abdominal pain and rectal bleeding with acute anemization. Both the gastroscopy and the colonoscopy dont identify any potential cause of bleeding. The computed tomography (CT) shows a pseudoaneurysm of the splenic artery. Gastrointestinal bleeding was attributed to a hemosuccus pancreaticus secondary to the pseudoaneurysm of the splenic artery. An arteriography was performed to embolize it. Pseudoaneurysm of the splenic artery is a rare cause of gastrointestinal bleeding. Given the risk of a rupture, the treatment is mandatory irrespective of the size or symptoms.
Pseudoaneurysm
Gastrointestinal bleeding
Upper Gastrointestinal Bleeding
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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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Pseudoaneurysm
Necrotizing pancreatitis
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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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Chronic pancreatitis is known to cause vascular complications including pseudoaneurysm of peripancreatic arteries that can lead to massive gastrointestinal bleeding. We report a 30-year-old man with splenic artery pseudoaneurysm formation secondary to chronic pancreatitis. The bleeding was successfully controlled by superselective microcoils embolization of the pseudoaneurysm with splenic preservation. The patient was discharged in 2 days with complete recovery. We consider superselective transcatheter embolization as one of the safest procedures and should be considered as a therapeutic option in the management of pseudoaneurysm caused by pancreatitis.
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ABSTRACT In pancreatitis the involvement of adjacent vessels resulting in pseudoaneurysm formation is well known, though quite rare (Gadacz 1978, Kadell & Riley 1967). The diagnosis is usually established on angiography or surgery. We report here a case where the diagnosis of a splenic artery pseudoaneurysm incorporated within an infected pseudocyst, was made sonographically.
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Pancreatic pseudocyst
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Pseudoaneurysm
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Splenic artery pseudoaneurysm, a rare complication of pancreatitis, carries a potentially high mortality rate and must be considered in recurrent pancreatitis. Advances in diagnostic and therapeutic techniques, especially endovascular embolization, have decreased morbidity and mortality. We present a pediatric patient with splenic artery pseudoaneurysm following recurrent pancreatitis managed with endovascular embolization.
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